Provider Demographics
NPI:1861498115
Name:BEIDLE, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:BEIDLE
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:PO BOX 7055
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-7055
Mailing Address - Country:US
Mailing Address - Phone:775-823-1999
Mailing Address - Fax:775-823-1996
Practice Address - Street 1:1155 MILL STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89520-1576
Practice Address - Country:US
Practice Address - Phone:775-982-8100
Practice Address - Fax:775-982-4161
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV94072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300112205OtherRAILROAD MEDICARE
NV2016859Medicaid
NV2016859Medicaid
NVV33772Medicare PIN
NV33772Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID