| NPI | 1174108674 |
|---|---|
| Former Legal Business Name | DONALD J BEASLEY SOLE MBR |
| Entity Type | Organization |
| Authorized Contact | DONALD J BEASLEY Owner 208-229-2368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2021-05-25 |