Basic Information
| Provider Information | |||||||||
| NPI: | 1760073506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JESSE BEARD ORTHOPEDICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 MAPLE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567779 | ||||||||
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| Practice Location | |||||||||
| Address1: | 606 MAPLE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 636401976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737567779 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2021 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | BEARD | ||||||||
| AuthorizedOfficialFirstName: | JESSE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5737476575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.