Provider Demographics
NPI:1588653992
Name:BEETNER, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:BEETNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:APLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:50604-1007
Mailing Address - Country:US
Mailing Address - Phone:319-347-6071
Mailing Address - Fax:
Practice Address - Street 1:515 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2500
Practice Address - Country:US
Practice Address - Phone:319-268-3000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02467Medicare UPIN