Provider Demographics
NPI:1144248477
Name:BEAUCLAIR, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BEAUCLAIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-445-4873
Mailing Address - Fax:626-445-4878
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-445-4873
Practice Address - Fax:626-445-4878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG17614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40131Medicare UPIN
CAG17614Medicare ID - Type Unspecified