Provider Demographics
NPI:1548369341
Name:BEAUMONT, KELLY DEAN (PA)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:DEAN
Last Name:BEAUMONT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1240 E 100 S STE 14
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-3005
Mailing Address - Country:US
Mailing Address - Phone:435-628-8232
Mailing Address - Fax:435-674-7994
Practice Address - Street 1:1240 E 100 S STE 14
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-3005
Practice Address - Country:US
Practice Address - Phone:435-628-8232
Practice Address - Fax:435-674-7994
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT100872-12062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine