Provider Demographics
NPI:1184630121
Name:BEUTLER, STEVEN MERRILL (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MERRILL
Last Name:BEUTLER
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:PO BOX 2095
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-2095
Mailing Address - Country:US
Mailing Address - Phone:951-738-0968
Mailing Address - Fax:951-738-0524
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:951-738-0968
Practice Address - Fax:951-738-0524
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39216207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G392160Medicaid
CA00G392160Medicaid
CA00G392160Medicare ID - Type Unspecified