Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS-004131L | PA |
Y | 208D00000X | General Practice Physician | OS 004131L | PA |
NPI | 1285688002 |
---|---|
Provider Name | Dr. Walter D Beam |
First Address | Irwin, PA 15642-1438 |
Second Address | Irwin, PA 15642-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 30/05/2008 |