| Blake R. Beazer, M.d., Inc | |
|
2356 N 400 E Ste. 201 Tooele UT 84074-3409 | |
| (435) 882-2350 | |
| (435) 882-2039 |
| Full Name | Blake R. Beazer, M.d., Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2356 N 400 E, Tooele, Utah |
| Authorized Official Name and Position | Blake Richard Beazer (MEDICAL DOCTOR) |
| Authorized Official Contact | 4358822358 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blake R. Beazer, M.d., Inc 2356 N 400 E Ste. 201 Tooele UT 84074-3409 Ph: (435) 882-2350 | Blake R. Beazer, M.d., Inc 2356 N 400 E Ste. 201 Tooele UT 84074-3409 Ph: (435) 882-2350 |
| NPI Number | 1184807992 |
|---|---|
| Provider Enumeration Date | 12/14/2007 |
| Last Update Date | 01/10/2014 |
| Medicare PECOS PAC ID | 1850323619 |
|---|---|
| Medicare Enrollment ID | O20050901000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184807992 | NPI | - | NPPES |
| 000057289 | Other | UT | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 52480801205 (Utah) | Primary |
| Provider Name | Marlee Kestin Dalton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730175761 PECOS PAC ID: 5294710638 Enrollment ID: I20040621001237 |
| Provider Name | Blake R Beazer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073510012 PECOS PAC ID: 5395702963 Enrollment ID: I20041217000245 |
| Provider Name | Connie D Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013210236 PECOS PAC ID: 2466623582 Enrollment ID: I20110922000066 |
| Provider Name | Elizabeth Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922376383 PECOS PAC ID: 1254596091 Enrollment ID: I20120629000364 |
| Provider Name | Alyssa Dawn Vest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497104368 PECOS PAC ID: 7719274893 Enrollment ID: I20160919001219 |
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