Provider Demographics
NPI:1750509139
Name:BEILSTEIN, DAVID PAUL
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:BEILSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:BEILSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:422 LARKFIELD CTR # 271
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1408
Mailing Address - Country:US
Mailing Address - Phone:707-578-5599
Mailing Address - Fax:
Practice Address - Street 1:422 LARKFIELD CTR # 271
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1408
Practice Address - Country:US
Practice Address - Phone:707-578-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2809213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28091Medicare ID - Type Unspecified
CAT11477Medicare UPIN