Blake Richard Beazer, MD
Family Medicine in Tooele, UT. Individual provider (NPI-1).
NPI number1073510012
StatusActive
Last updated in NPPESMar 21, 2014
Details
- NPI
- 1073510012
- Entity type
- Individual (NPI-1)
- Name
- Blake Richard Beazer
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 6, 2005
- Last updated
- Mar 21, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 5248080-1205 | UT | Yes |
Practice location
2356 N 400 ESte 201
Tooele, UT 84074
Phone 435-882-2350 · Fax 435-882-2039
Mailing address
2356 N 400 ESte 201
Tooele, UT 84074
Phone 435-882-2350 · Fax 435-882-2039
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