Provider Demographics
NPI:1912239690
Name:BEAHM, LANCE ARTHUR (PA)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:ARTHUR
Last Name:BEAHM
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2005 KNIGHT LANE BLDG. H
Mailing Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 3RD ST W BLDG 1040
Practice Address - Street 2:
Practice Address - City:JBSA RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-221-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2020-06-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant