Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 27285 | MN |
Y | 207Q00000X | Family Doctor | 27285 | MN |
NPI | 1235166992 |
---|---|
Provider Name | Dr. Bryant Richard Beehler |
First Address | Andover, MN 55304-3283 |
Second Address | Andover, MN 55304-3283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 28/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A95186 | (02) | MN |