Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 0199 | AZ |
Y | 207Q00000X | Family Doctor | 0199 | AZ |
NPI | 1639174493 |
---|---|
Provider Name | Gary Beitler |
First Address | Higley, AZ 85236-1565 |
Second Address | Mesa, AZ 85206-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 27/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65841 | (02) | UT |