Individual
DR. DAVID M BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7437
(217) 698-9722
(217) 391-0392
Mailing address
PO BOX 500, CHATHAM, IL 62629-0500
(217) 670-2424
(217) 670-2809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036112014
IL
207Q00000X
Family Medicine Physician
38680
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
036112014
STATE LICENSE
IL
01
—
08421024
BCBS
IL
01
—
130434
HEALTH ALLIANCE
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0435365
CLIA CERT CHATHAM LOC
IL
01
—
14D0949277
CLIA CERT SPFLD LOC
IL
01
—
310046
PERSONAL CARE
IL
01
—
6394P
CATERPILLAR
IL
01
—
787412
HEALTHLINK
IL
01
—
CD7143
RR MEDICARE GROUP
IL
01
—
P00397731
RR MEDICARE IND PROV ID
IL
Enumeration date
08/05/2006
Last updated
12/16/2011
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