Provider Demographics
NPI:1396921904
Name:SCOTT D BEEDE MD PA
Entity type:Organization
Organization Name:SCOTT D BEEDE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEEDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-395-0455
Mailing Address - Street 1:951 NW 13TH ST STE 4C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2337
Mailing Address - Country:US
Mailing Address - Phone:561-395-0455
Mailing Address - Fax:561-395-3032
Practice Address - Street 1:951 NW 13TH ST STE 4C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-395-0455
Practice Address - Fax:561-395-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE7266Medicare PIN
FLF16456Medicare UPIN
FLK9116Medicare PIN