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Contact Information

BRUCE W BEAUCHAMP, DO
4021 S 700 E
SUITE 220
SALT LAKE CITY, UT84107-2192
 Phone: 800-211-4971
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiology

207L00000X 79 Physician/Addiction Medicine
Indicates primary specialty

NPI Profile & details for BRUCE W BEAUCHAMP · (Male)

NPI Number 1609881036
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/31/2006
Last updated 05/18/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • AK License # 5697
  • AZ License # 3891
  • ID License # 0.198
  • MO License # DO 116462
  • ND License # 10096
  • OR License # 16476
  • WA License # 1260
  • WV License # 1499
  • ND Medicaid 14198
  • MN Other 1417978057 DEPT OF HUMAN SERVICES
  • ND Other 20-03471 MEDICA
  • ND Other 28761 ND BLUE CROSS BLUE SHIELD
  • ND Other A06171050226 PREFERRED ONE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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