Individual
JEFFREY BLAIR BEAUDOIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
521 MONROE ST, PETOSKEY, MI 49770-2266
(231) 487-1900
(231) 348-0984
Mailing address
521 MONROE ST, PETOSKEY, MI 49770-2266
(231) 487-1900
(231) 348-0984
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301057924
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020043565
RAILROAD MEDICARE
MI
01
—
020B41012
BCBS MI
MI
01
—
0B41012
BCN
MI
05
—
4084724
—
MI
Enumeration date
04/18/2006
Last updated
11/19/2015
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