Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036-043906 | IL |
N | 208000000X | Pediatrician | 036-043906 | IL |
N | 2080P0201X | Pediatric Allergist | 036-043906 | IL |
NPI | 1205892478 |
---|---|
Provider Name | Dr. Howard Earl Beede |
First Address | Decatur, IL 62526-3950 |
Second Address | Decatur, IL 62526-3950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 16/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036043906 | (05) | IL |
C45650 | (02) | IL |