Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD014137 | LA |
N | 208000000X | Pediatrician | MD014137 | LA |
N | 208000000X | Pediatrician | MD13396 | TN |
Y | 2080P0204X | Pediatric Emergency Doctor | MD014137 | LA |
N | 2080P0204X | Pediatric Emergency Doctor | MD13396 | TN |
NPI | 1124115035 |
---|---|
Provider Name | Stephen Littlefield Beasley |
First Address | Baton Rouge, LA 70808-4375 |
Second Address | Baton Rouge, LA 70809-3489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000476759B | (05) | GA |
009910799 | (05) | AL |
009940173 | (05) | AL |
03178354 | (05) | MS |
1968374 | (05) | LA |
3011747 | (05) | TN |
4140363 | BLUE CROSS (01) | TN |
F50442 | (02) |