Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD06705 | OR |
NPI | 1114921103 |
---|---|
Provider Name | Duane Gary Beard |
First Address | Salem, OR 97301-3891 |
Second Address | Salem, OR 97301-3891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010561 | (05) | OR |
C92170 | (02) |