Provider Demographics
NPI:1073563805
Name:BEYER, PAUL HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOWARD
Last Name:BEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4422 3RD AVENUE
Mailing Address - Street 2:CARE OF EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-960-6103
Mailing Address - Fax:718-960-6125
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:CARE OF EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6103
Practice Address - Fax:718-960-6125
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209202207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01828133Medicaid
NY01828133Medicaid