Individual
DR. JACKIE BEENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Mailing address
1540 E EVERGREEN ST, SPRINGFIELD, MO 65803-4300
(417) 823-2900
(417) 886-2774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R1I02
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202538732
—
MO
01
—
P00065361
RR MEDICARE
—
Enumeration date
06/27/2005
Last updated
07/28/2022
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