Provider Demographics
NPI:1235166992
Name:BEEHLER, BRYANT RICHARD (DO,FP,NMM-OMM)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:RICHARD
Last Name:BEEHLER
Suffix:
Gender:M
Credentials:DO,FP,NMM-OMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14133 ORCHID ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3283
Mailing Address - Country:US
Mailing Address - Phone:763-421-6546
Mailing Address - Fax:763-421-6546
Practice Address - Street 1:14133 ORCHID ST NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3283
Practice Address - Country:US
Practice Address - Phone:763-421-6546
Practice Address - Fax:763-421-6546
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27285204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95186Medicare UPIN