Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 0101228192 | VA |
NPI | 1043203607 |
---|---|
Provider Name | Dr. Douglas Beakes |
First Address | Fairfax, VA 22033-1744 |
Second Address | Bethesda, MD 20889-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 14/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010391733 | (05) | VA |
I63987 | (02) | VA |