Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 01040296 | IN |
Y | 207L00000X | Anesthesiologist | 01040296A | IN |
NPI | 1003854423 |
---|---|
Provider Name | Christian N Beaton |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100121310 | (05) | IN |
F00479 | (02) | IN |