Provider Demographics
NPI:1386642577
Name:BEIGHLE, JOHN K (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:BEIGHLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SELWAY DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9314
Mailing Address - Country:US
Mailing Address - Phone:406-240-4593
Mailing Address - Fax:
Practice Address - Street 1:1801 SELWAY DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9314
Practice Address - Country:US
Practice Address - Phone:406-240-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT113213E00000X, 213ES0131X
MT219938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0390422Medicaid
MT000007931OtherBCBS
MT000083940Medicare ID - Type Unspecified
MT000007931OtherBCBS