Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A024751 | CA |
NPI | 1417070707 |
---|---|
Provider Name | Dr. Forrest O Beaty |
First Address | Forestville, CA 95436-1427 |
Second Address | Forestville, CA 95436-9629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A247511 | (05) | CA |
A24114 | (02) | CA |