Provider Demographics
NPI:1114921103
Name:BEARD, DUANE GARY (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:GARY
Last Name:BEARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BELLEVUE ST SE
Mailing Address - Street 2:#245
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3891
Mailing Address - Country:US
Mailing Address - Phone:503-371-0606
Mailing Address - Fax:503-371-0604
Practice Address - Street 1:700 BELLEVUE ST SE
Practice Address - Street 2:#245
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3891
Practice Address - Country:US
Practice Address - Phone:503-371-0606
Practice Address - Fax:503-371-0604
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD06705207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR010561Medicaid
ORR0000BHBLMMedicare ID - Type Unspecified
OR010561Medicaid