Individual
JEFFREY R BEARDMORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-8335
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01036498A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000182104
ANTHEM PROVIDER NUMBER
IN
01
—
10824762
CAQH NUMBER
IN
01
—
9062912
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
07/09/2007
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