Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301046890 | MI |
NPI | 1295718138 |
---|---|
Provider Name | Roger Dennis Beyer |
First Address | Kalamazoo, MI 49009-9423 |
Second Address | Kalamazoo, MI 49009-9423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 07/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0800024 | BLUE CROSS BLUE SHIELD (01) | MI |
2784859 | (05) | MI |
B47483 | (02) |