Provider Demographics
NPI:1063421683
Name:BEOUGHER, SCOTT J (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:BEOUGHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 CHESAPEAKE CT
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1329
Mailing Address - Country:US
Mailing Address - Phone:920-303-2254
Mailing Address - Fax:
Practice Address - Street 1:5165 CHESAPEAKE CT
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1329
Practice Address - Country:US
Practice Address - Phone:920-303-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47066207Q00000X
MI5101014920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine