Individual
DR. CAMILLE MERCEDES GARDNER-BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9040A JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-0001
(253) 968-1110
Mailing address
10444 LONGMIRE RD, JOINT BASE LEWIS MCCHORD, WA 98433-1357
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
200700182
NC
207Q00000X
Family Medicine Physician
Primary
7564
AK
207Q00000X
Family Medicine Physician
MEDS7564
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581405
—
AK
05
—
5914115
—
NC
05
—
MDA0514
—
AK
Enumeration date
12/16/2005
Last updated
04/02/2019
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