Provider Demographics
NPI:1386368496
Name:BEECH, MARK IAN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:IAN
Last Name:BEECH
Suffix:
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 1:1025 DIVISION ST STE C
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2910
Mailing Address - Country:US
Mailing Address - Phone:228-388-2599
Mailing Address - Fax:
Practice Address - Street 1:1025 DIVISION ST STE C
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2910
Practice Address - Country:US
Practice Address - Phone:228-388-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily