Basic Information
Provider Information | |||||||||
NPI: | 1205990579 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEACH | ||||||||
FirstName: | RONALD | ||||||||
MiddleName: | L | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 227 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | FESTUS | ||||||||
State: | MO | ||||||||
PostalCode: | 630281952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6369312700 | ||||||||
FaxNumber: | 6369312139 | ||||||||
Practice Location | |||||||||
Address1: | 227 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | FESTUS | ||||||||
State: | MO | ||||||||
PostalCode: | 630281952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6369312700 | ||||||||
FaxNumber: | 6369312139 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/21/2006 | ||||||||
LastUpdateDate: | 12/14/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | R6715 | MO | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | BB1653737 | 01 | MO | DEA | OTHER | 24959 | 01 |   | BOARD CERTIFICATE | OTHER | 27090 | 01 | MO | BNDD | OTHER |