Provider Demographics
NPI:1972718658
Name:BEUTLER, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BEUTLER
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 1:1975 MARTHA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7580
Mailing Address - Country:US
Mailing Address - Phone:208-522-4598
Mailing Address - Fax:208-529-3915
Practice Address - Street 1:1975 MARTHA AVE STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7580
Practice Address - Country:US
Practice Address - Phone:208-522-4598
Practice Address - Fax:208-529-3915
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9048207LP2900X
PAMT187835207R00000X
WY8973A207LP2900X
IDM-12141207LP2900X
SD9063207L00000X
UT8622635-1205207LP2900X
MI4301091543207L00000X
MTMED-PHYS-LIC-29693207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology