Provider Demographics
NPI:1578953378
Name:BEER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BEER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:574-658-3500
Mailing Address - Fax:574-658-3501
Practice Address - Street 1:2300 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3213
Practice Address - Country:US
Practice Address - Phone:574-267-6778
Practice Address - Fax:574-267-3134
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001808A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant