Individual
DR. SALLY BEAZLIE-WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
209 E JEFFERSON ST, PLYMOUTH, IN 46563-1861
(574) 948-5100
(574) 348-0745
Mailing address
707 CEDAR ST STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8707
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02005023A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001109741
BCBS
IN
01
—
187720067
MEDICARE PTAN
IN
05
—
300004357
—
IN
01
—
P01887772
RR PTAN
IN
Enumeration date
07/04/2008
Last updated
06/16/2018
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