Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01057410A | IN |
NPI | 1184672107 |
---|---|
Provider Name | Dr. Jeffrey Corbett Beach |
First Address | Indianapolis, IN 46206-6069 |
Second Address | Carmel, IN 46032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H96428 | (02) | |
H96428 | (02) | IN |