Provider Demographics
NPI:1205938800
Name:BEAUCHAMP, DELBERT H JR (PA-C)
Entity type:Individual
Prefix:
First Name:DELBERT
Middle Name:H
Last Name:BEAUCHAMP
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2550
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-227-2457
Practice Address - Street 1:2150 S CENTRAL EXPY
Practice Address - Street 2:STE 130
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4070
Practice Address - Country:US
Practice Address - Phone:214-714-7010
Practice Address - Fax:972-363-8196
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00653363AS0400X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88N110OtherBCBS
TX189238201Medicaid
81N666Medicare PIN
TX88N110OtherBCBS