Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 01075091A | IN |
N | 207X00000X | Orthopaedic Surgeon | MD60440572 | WA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01075091A | IN |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD60440572 | WA |
NPI | 1306075742 |
---|---|
Provider Name | Matthew W Beuchel |
First Address | Fort Wayne, IN 46801-2526 |
Second Address | Fort Wayne, IN 46804-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000939417 | ANTHEM (01) | |
000000939417 | ANTHEM (01) | IN |
0135798 | (05) | OH |
1306075742 | (05) | WA |
201289140 | (05) | IN |