Individual
GARY RICHARD BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
730 W MARKET ST, LIMA, OH 45801-4602
(419) 227-3361
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34004459B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000317852
BCBS
OH
01
—
000000317852
BCBS
—
05
—
0680919
—
OH
01
—
P00072684
MEDICARE RR
OH
Enumeration date
05/25/2006
Last updated
05/16/2008
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