Basic Information
| Provider Information | |||||||||
| NPI: | 1396208310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEER | ||||||||
| FirstName: | CODY | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093474277 | ||||||||
| FaxNumber: | 3093474388 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093474277 | ||||||||
| FaxNumber: | 3093474388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2019 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 209018970 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 309014113 | 01 | IL | CONTROLLED SUBSTANCE LICENSE | OTHER | 041431013 | 01 | IL | REGISTERED PROFESSIONAL NURSE | OTHER | 209018970 | 01 | IL | ADVANCED PRACTICE REGISTERED NURSE | OTHER |