Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME120238 | FL |
N | 207W00000X | Ophthalmologist | N7218 | TX |
NPI | 1003120262 |
---|---|
Provider Name | Dr. Casey Justin Beal |
First Address | Gainesville, FL 32610-0284 |
Second Address | Gainesville, FL 32610-0284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2010 |
Last Update Date | 01/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012369300 | (05) | FL |