Provider Demographics
NPI:1366416943
Name:BEACH, DON E (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:E
Last Name:BEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 LAWRENCE ST
Mailing Address - Street 2:P.O. BOX 8
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1532
Mailing Address - Country:US
Mailing Address - Phone:256-974-6646
Mailing Address - Fax:256-974-8654
Practice Address - Street 1:633 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1532
Practice Address - Country:US
Practice Address - Phone:256-974-6646
Practice Address - Fax:256-974-8654
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085794Medicaid
AL009936932Medicaid
ALD24167Medicare UPIN
AL051557669Medicare ID - Type Unspecified
AL009936932Medicaid