Provider Demographics
NPI:1992961387
Name:BEAUJON, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:BEAUJON
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 108
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0003
Mailing Address - Country:US
Mailing Address - Phone:972-249-9783
Mailing Address - Fax:972-805-9587
Practice Address - Street 1:1418 TARTAN DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4653
Practice Address - Country:US
Practice Address - Phone:972-249-9783
Practice Address - Fax:972-805-9587
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2028326-01Medicaid
TX613932Medicare PIN