Individual
KEITH ALAN BEAUCHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
106 BUTLER ST, SUITE A, MACON, MO 63552-1629
(660) 385-4464
(660) 385-1449
Mailing address
106 BUTLER ST, P.O. BOX 447, MACON, MO 63552-1629
(660) 385-4464
(660) 385-1449
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000737
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308527605
—
MO
01
—
626227508
MEDICAID DME
MO
Enumeration date
08/03/2005
Last updated
08/08/2023
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