Basic Information
| Provider Information | |||||||||
| NPI: | 1992720700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAUMONT | ||||||||
| FirstName: | GRAHAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 BOVET RD | ||||||||
| Address2: | 6TH FLOOR - BOVET PROFESSIONAL CENTER CD BILLING, LLC | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012559279 | ||||||||
| FaxNumber: | 7012224142 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 S EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944035131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503496121 | ||||||||
| FaxNumber: | 6503497077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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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 | 2084P0800X | A024516 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | A24516 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.