Provider Demographics
NPI:1346362308
Name:BEELEK, GREGORY LOUIS (1045861)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LOUIS
Last Name:BEELEK
Suffix:
Gender:M
Credentials:1045861
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Mailing Address - Street 1:857 FAIR LN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8715 VILLAGE DR STE 518
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5423
Practice Address - Country:US
Practice Address - Phone:210-590-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1045861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant