Provider Demographics
NPI:1730158627
Name:BEAUREGARD, CURTIS LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:LEE
Last Name:BEAUREGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12468 BRANTLEY COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:833-863-6633
Mailing Address - Fax:561-392-3793
Practice Address - Street 1:12468 BRANTLEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:833-863-6633
Practice Address - Fax:561-392-3793
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37010207T00000X, 208VP0014X
FL74193207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009492Medicaid
FLH81935Medicare UPIN
TN103I092250Medicare PIN
FLH81935Medicare UPIN