Individual
DR. RANDALL SCOTT BEALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7301 ROGERS AVE, 4T, FORT SMITH, AR 72903-4100
(479) 782-5500
(479) 782-5502
Mailing address
PO BOX 11106, FORT SMITH, AR 72917-1106
(479) 459-5382
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E5627
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175007003
—
AR
05
—
200199460A
—
OK
01
—
5H230
BCBS
AR
Enumeration date
05/10/2006
Last updated
03/18/2013
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