Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | ME40826 | FL |
NPI | 1639397540 |
---|---|
Provider Name | Dr. Rick A Beach |
First Address | Gulf Breeze, FL 32561-7809 |
Second Address | Gulf Breeze, FL 32561-7809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50756 | (02) | FL |