NPI 1053949701 · live from the CMS NPI Registry
Jeffrey Gary Beach, RDN
Dietitian, Registered in Detroit, MI. National Provider Identifier 1053949701, active.
NPI record
| NPI | 1053949701 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 13901 E Jefferson Ave, Detroit, MI 48215 |
| Practice phone | 313-822-0900 |
| Enumerated | March 30, 2020 |
| Last updated | April 1, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 86089803 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.