Provider Demographics
NPI:1982694535
Name:BEITZ, RICHARD THEODORE JR (DOCTOR OF OSTEOPATHY)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THEODORE
Last Name:BEITZ
Suffix:JR
Gender:M
Credentials:DOCTOR OF OSTEOPATHY
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:THEODORE
Other - Last Name:BEITZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5783 ADRIENNE CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8257
Mailing Address - Country:US
Mailing Address - Phone:719-359-1531
Mailing Address - Fax:
Practice Address - Street 1:5783 ADRIENNE CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8257
Practice Address - Country:US
Practice Address - Phone:719-359-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine