Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 12504972 | IL |
Y | 207X00000X | Orthopaedic Surgeon | 62950 | TN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 35095641 | OH |
NPI | 1346406956 |
---|---|
Provider Name | Dr. Matthew Dean Beal |
First Address | Fortson, GA 31808-0370 |
Second Address | Nashville, TN 37203-1558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2008 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3064035 | (05) | OH |