Provider Demographics
NPI:1013150580
Name:BEATTY, JASON L (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:BEATTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N STATE AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2835
Mailing Address - Country:US
Mailing Address - Phone:517-881-6199
Mailing Address - Fax:989-340-1512
Practice Address - Street 1:165 N STATE AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2835
Practice Address - Country:US
Practice Address - Phone:517-881-6199
Practice Address - Fax:989-340-1512
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018107207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty