Provider Demographics
NPI:1629069695
Name:BEAN, GREGORY H (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:BEAN
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 1:1248 E 90 N STE 300
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2956
Mailing Address - Country:US
Mailing Address - Phone:801-756-9635
Mailing Address - Fax:801-216-8357
Practice Address - Street 1:1248 E 90 N STE 300
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-9635
Practice Address - Fax:801-216-8357
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR35075241171000000X
UT6901969-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty