Provider Demographics
NPI:1316282288
Name:BEAUCHAMP, ROBERT FREDRICK (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FREDRICK
Last Name:BEAUCHAMP
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 1:1 E WASHINGTON ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2492
Mailing Address - Country:US
Mailing Address - Phone:602-255-8512
Mailing Address - Fax:602-255-8716
Practice Address - Street 1:1 E WASHINGTON ST
Practice Address - Street 2:SUITE 17
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2492
Practice Address - Country:US
Practice Address - Phone:602-255-8512
Practice Address - Fax:602-255-8716
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics