1356416440 NPI number — DOUGLAS RUDOLPH BEY JR. M.D.

Table of content: DR. DANIEL BRIAN GEELAN D.M.D (NPI 1477574242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356416440 NPI number — DOUGLAS RUDOLPH BEY JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEY
Provider First Name:
DOUGLAS
Provider Middle Name:
RUDOLPH
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356416440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 STEPHENS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61761-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-452-3263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BEECH ST
Provider Second Line Business Practice Location Address:
#10 NORMANDY VILLAGE
Provider Business Practice Location Address City Name:
NORMAL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61761-1493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-454-2112
Provider Business Practice Location Address Fax Number:
309-452-1265
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  3639852 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3639852 . This is a "LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0572016318 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 371127481 . This is a "TAX NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: L028076 . This is a "CHAMPUS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1200B . This is a "CATERPILLAR PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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