Provider Demographics
NPI:1972625986
Name:GARY E. BEAN MD, INC
Entity Type:Organization
Organization Name:GARY E. BEAN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-530-5437
Mailing Address - Street 1:4180 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1207
Mailing Address - Country:US
Mailing Address - Phone:510-530-5437
Mailing Address - Fax:510-530-9703
Practice Address - Street 1:4180 PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1207
Practice Address - Country:US
Practice Address - Phone:510-530-5437
Practice Address - Fax:510-530-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53663261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53663OtherLICENSE