Provider Demographics
NPI:1104518729
Name:BEASON, ADRIAN ALPHONZO JR
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:ALPHONZO
Last Name:BEASON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 VENETIAN ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2646
Mailing Address - Country:US
Mailing Address - Phone:305-332-2507
Mailing Address - Fax:
Practice Address - Street 1:AETNA HEALTHCARE
Practice Address - Street 2:261 N UNIVERSITY DRIVE
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:305-332-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP186996171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator