Provider Demographics
NPI:1326057357
Name:BEAN, JEFFREY K (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:BEAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701
Mailing Address - Country:US
Mailing Address - Phone:775-882-1441
Mailing Address - Fax:775-882-6844
Practice Address - Street 1:1801 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701
Practice Address - Country:US
Practice Address - Phone:775-882-1441
Practice Address - Fax:775-882-6844
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0101213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNA674338Medicaid
NVNA674338Medicaid
NV36484Medicare PIN