Basic Information
| Provider Information | |||||||||
| NPI: | 1710035431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | NEEDHAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 682 SKIVIEW TRL | ||||||||
| Address2: | |||||||||
| City: | GAYLORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039097676 | ||||||||
| FaxNumber: | 7074237419 | ||||||||
| Practice Location | |||||||||
| Address1: | GAYLORD VA CLINIC | ||||||||
| Address2: | 2782 S. OTSEGO AVE | ||||||||
| City: | GAYLORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 79735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894972500 | ||||||||
| FaxNumber: | 9897326577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 047054 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.