Basic Information
| Provider Information | |||||||||
| NPI: | 1689879751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCNULTY | ||||||||
| OtherFirstName: | HOLLY | ||||||||
| OtherMiddleName: | GOOD | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2917 | ||||||||
| Address2: | BANNER - UNIVERSITY MEDICAL GROUP | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850622917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703957878 | ||||||||
| FaxNumber: | 9703957880 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 E AJO WAY STE 200 | ||||||||
| Address2: | BANNER - UNIVERSITY MEDICAL GROUP | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206948000 | ||||||||
| FaxNumber: | 5208744801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35375 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 35375 | 01 | AZ | STATE LICENSE | OTHER | P00447250 | 01 | AZ | RAILROAD MEDICARE | OTHER | 222954 | 05 | AZ | MEDICAID |