Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E-3999 | AR |
N | 111NI0900X | Internist | E-3999 | AR |
N | 207RC0200X | Critical Care Medicine | 04-31282 | KS |
N | 207RC0200X | Critical Care Medicine | 28270 | OK |
Y | 207RC0200X | Critical Care Medicine | 68486 | WI |
N | 207RC0200X | Critical Care Medicine | E-3999 | AR |
N | 2084N0400X | Neurologist | 04-31282 | KS |
N | 2084N0400X | Neurologist | 28270 | OK |
N | 2084N0400X | Neurologist | E-3999 | AR |
NPI | 1023019304 |
---|---|
Provider Name | Dr. Rodney J Beasley |
First Address | Appleton, WI 54911-5794 |
Second Address | Tulsa, OK 74133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200329750A | (05) | KS |
309292 | STATE LICENSE (01) | LA |
I04067 | (02) | AR |
I04067 | (02) | KS |