Provider Demographics
NPI:1396208310
Name:BEER, CODY (APN)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BEER
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6246
Mailing Address - Country:US
Mailing Address - Phone:309-347-4277
Mailing Address - Fax:309-347-4388
Practice Address - Street 1:3400 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6246
Practice Address - Country:US
Practice Address - Phone:309-347-4277
Practice Address - Fax:309-347-4388
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309014113OtherCONTROLLED SUBSTANCE LICENSE
IL041431013OtherREGISTERED PROFESSIONAL NURSE
IL209018970OtherADVANCED PRACTICE REGISTERED NURSE