Provider Demographics
NPI:1306819198
Name:BEAN, DAVID K (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:BEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14021 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2708
Practice Address - Country:US
Practice Address - Phone:314-839-0910
Practice Address - Fax:314-839-9053
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00047620OtherRAILROAD MEDICARE
MOP00047620OtherRAILROAD MEDICARE
MOA11848Medicare UPIN