Basic Information
| Provider Information | |||||||||
| NPI: | 1609044262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14951 66TH ST NE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585219711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016733432 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765261 | ||||||||
| FaxNumber: | 7017765448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2008 | ||||||||
| LastUpdateDate: | 02/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5445 | ND | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | 5445 | ND | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.