Provider Demographics
NPI:1447213970
Name:BEESLEY, BRIAN J (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:BEESLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:815 W BROAD ST STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1464
Practice Address - Country:US
Practice Address - Phone:614-223-1532
Practice Address - Fax:614-223-1732
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2081590Medicaid
G76432Medicare UPIN
OH2081590Medicaid