Provider Demographics
NPI:1740366392
Name:BEISLER, ANTHONY JOHN IV (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:BEISLER
Suffix:IV
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 1:2160 EWING CRAWFIS CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9042
Mailing Address - Country:US
Mailing Address - Phone:937-292-7354
Mailing Address - Fax:937-292-7528
Practice Address - Street 1:2160 EWING CRAWFIS CIR
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9042
Practice Address - Country:US
Practice Address - Phone:937-292-7354
Practice Address - Fax:937-292-7528
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0584084208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2598041Medicaid
OHI43090Medicare UPIN
OHBE4170501Medicare ID - Type Unspecified