Beazer, Blake Richard
Beazer, Blake Richard is an individual health care provider with primary practice located at 2356 N 400 E Ste 201, Tooele UT 84074. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Beazer, Blake Richard can be contacted via phone (435) 882-2350.Contact Information
Primary practice address
2356 N 400 E Ste 201
Tooele UT 84074
Phone: (435) 882-2350
Fax: (435) 882-2039
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 5248080-1205 | Utah |
Profile Details
| NPI number | 1073510012 |
|---|---|
| LBN Legal business name | Beazer, Blake Richard |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 6th, 2005 |
| Last updated | Mar 21st, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073510012 | NPPES |
| Utah | MEDICAID | D4916 |
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