Basic Information
| Provider Information | |||||||||
| NPI: | 1326015546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEECH | ||||||||
| FirstName: | DERRICK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7080 CANONBURY PL | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303281934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158871114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 MAUI LANI PKWY | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967932416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084425700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 056091 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | 53390 | AZ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 2086X0206X | 056091 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 2086X0206X | MD-18903 | HI | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3839168 | 05 | TN | MEDICAID | 003114446A | 05 | GA | MEDICAID |