Provider Demographics
NPI:1548220395
Name:BEALL, GREGORY D (MD)
Entity Type:Individual
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First Name:GREGORY
Middle Name:D
Last Name:BEALL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:3960 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2569
Practice Address - Country:US
Practice Address - Phone:763-236-9400
Practice Address - Fax:763-236-9423
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN22118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A95761Medicare UPIN