Individual
THOMAS PATRICK BEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
750 N SYRINGA ST STE 203, POST FALLS, ID 83854-5275
(208) 415-0800
(208) 415-0174
Mailing address
750 N SYRINGA ST STE 203, POST FALLS, ID 83854-5275
(208) 415-0800
(208) 415-0174
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
29197
MN
174400000X
Specialist
5147
MT
174400000X
Specialist
M5057
ID
174400000X
Specialist
MD00022835
WA
174400000X
Specialist
MD025690-E
PA
207Y00000X
Otolaryngology Physician
Primary
M5057
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000501700
—
ID
05
—
0057120
—
MT
05
—
11014026
—
WA
01
—
13575
DEPT. OF L&I
WA
01
—
22092
REGENCE BLUE SHIELD
ID
01
—
5057-5
BLUE CROSS OF IDAHO
ID
Enumeration date
10/25/2006
Last updated
10/09/2020
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