Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2009009697 | MO |
N | 207Q00000X | Family Doctor | 2009009697 | MO |
Y | 207Q00000X | Family Doctor | 9398 | SD |
N | 207Q00000X | Family Doctor | T2006016520 | MO |
NPI | 1013010081 |
---|---|
Provider Name | Mark Nelson Beard |
First Address | Columbia, MO 65205-7687 |
Second Address | Sioux Falls, SD 57105-4252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 02/10/2019 |