Provider Demographics
NPI:1578833695
Name:JOHN R. BEYER, D. O., PLLC
Entity type:Organization
Organization Name:JOHN R. BEYER, D. O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:616-928-0034
Mailing Address - Street 1:44 E 8TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3575
Mailing Address - Country:US
Mailing Address - Phone:616-928-0034
Mailing Address - Fax:616-928-0036
Practice Address - Street 1:44 E 8TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3575
Practice Address - Country:US
Practice Address - Phone:616-928-0034
Practice Address - Fax:616-928-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010078892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5700101OtherBLUE CROSS BLUE SHIELD
MI5700101OtherBLUE CROSS BLUE SHIELD