Provider Demographics
NPI:1043025190
Name:BEAN, LEROY DEVON
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:DEVON
Last Name:BEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 NIGHTWIND CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1358
Mailing Address - Country:US
Mailing Address - Phone:937-559-0111
Mailing Address - Fax:
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2708
Practice Address - Country:US
Practice Address - Phone:937-965-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist