Provider Demographics
NPI:1285719708
Name:BEATON, THOMAS PATRICK (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:BEATON
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 1:750 N SYRINGA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5275
Mailing Address - Country:US
Mailing Address - Phone:208-415-0800
Mailing Address - Fax:208-415-0174
Practice Address - Street 1:750 N SYRINGA ST STE 203
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5275
Practice Address - Country:US
Practice Address - Phone:208-415-0800
Practice Address - Fax:208-415-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5057174400000X, 207Y00000X
MN29197174400000X
PAMD025690-E174400000X
MT5147174400000X
WAMD00022835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13575OtherDEPT. OF L&I
ID5057-5OtherBLUE CROSS OF IDAHO
ID000501700Medicaid
MT0057120Medicaid
ID22092OtherREGENCE BLUE SHIELD
WA11014026Medicaid
WA13575OtherDEPT. OF L&I
MT0057120Medicaid