Provider Demographics
NPI:1932190774
Name:BEAMAN, JOHN MALCOLM (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MALCOLM
Last Name:BEAMAN
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:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-1650
Mailing Address - Country:US
Mailing Address - Phone:601-788-6321
Mailing Address - Fax:601-788-6362
Practice Address - Street 1:302 BAY AVE.
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476
Practice Address - Country:US
Practice Address - Phone:601-788-6321
Practice Address - Fax:601-788-6362
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010503Medicaid
MS00010503Medicaid