Individual
WILLIAM THOMAS BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4602 SOUTHERN PKWY, LOUISVILLE, KY 40214-1442
(502) 366-1479
(502) 366-6718
Mailing address
4602 SOUTHERN PKWY, LOUISVILLE, KY 40214-1442
(502) 366-1479
(502) 366-6718
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07000339A
IN
213E00000X
Podiatrist
Primary
126
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075860
—
IN
01
—
1054679
PASSPORT
—
05
—
80001266
—
KY
05
—
90125568
—
KY
Enumeration date
08/10/2005
Last updated
02/04/2013
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