Individual
JOHN GREGORY BEAUCLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3838 12TH AVE N, FARGO, ND 58102-2931
(701) 234-4700
(701) 234-4757
Mailing address
3838 12TH AVE N, FARGO, ND 58102-2931
(701) 234-4700
(701) 234-4757
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
5218
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15009
—
ND
Enumeration date
07/18/2006
Last updated
03/29/2022
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