Provider Demographics
NPI:1649217936
Name:BEUTNER, KARL REINHARD (MD PHD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:REINHARD
Last Name:BEUTNER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2929
Mailing Address - Country:US
Mailing Address - Phone:707-643-5785
Mailing Address - Fax:707-643-8810
Practice Address - Street 1:480 CHADBOURNE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9647
Practice Address - Country:US
Practice Address - Phone:707-399-4500
Practice Address - Fax:707-399-9527
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43543207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ97788ZOtherMEDICARE GROUP PTAN
CAGR0023150Medicaid
CAGR0023150Medicaid
CA00G43543Medicare ID - Type Unspecified