Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD19625 | OR |
NPI | 1003808460 |
---|---|
Provider Name | Dr. Michele K Beaman |
First Address | Hood River, OR 97031-9785 |
Second Address | Hood River, OR 97031-9785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2005 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G25600 | (02) |