Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101046574 | VA |
NPI | 1205888997 |
---|---|
Provider Name | Dr. William R Beach |
First Address | Richmond, VA 23255-1690 |
Second Address | Richmond, VA 23226-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200008450 | GEORGIA RR MEDICARE (01) | |
227701 | ANTHEM (01) | VI |
E32417 | (02) |