Individual
TIMOTHY BEACHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4201 SPRINGHURST BLVD STE 102, LOUISVILLE, KY 40241-6156
(502) 352-2530
Mailing address
4201 SPRINGHURST BLVD STE 102, LOUISVILLE, KY 40241-6156
(502) 515-4902
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20443
MS
207LP2900X
Pain Medicine (Anesthesiology) Physician
20443
MS
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
49929
KY
208VP0014X
Interventional Pain Medicine Physician
20443
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04330519
—
MS
01
—
302I057501
MEDICARE PTAN
MS
01
—
343174YXV2
MEDICARE PTAN
MO
05
—
7100473360
—
KY
Enumeration date
07/05/2007
Last updated
06/17/2024
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