Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 4699 | NC |
NPI | 1427596402 |
---|---|
Provider Name | Dr. Andrew Ray Beachum |
First Address | Winter Park, FL 32792-3800 |
Second Address | Winter Park, FL 32792-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 17/10/2018 |