Basic Information
Provider Information | |||||||||
NPI: | 1518324771 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEER | ||||||||
FirstName: | VICTOR | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BEER | ||||||||
OtherFirstName: | VICTOR | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 5771 N CHIEFTAN TRL | ||||||||
Address2: |   | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857501304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5203821205 | ||||||||
FaxNumber: | 5207950225 | ||||||||
Practice Location | |||||||||
Address1: | 6565 E. CARONDELET DRIVE | ||||||||
Address2: | SUITE 175 | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 85710 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5205475960 | ||||||||
FaxNumber: | 5205475969 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/19/2016 | ||||||||
LastUpdateDate: | 09/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 52449 | AZ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 42376 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 234259 | 05 | AZ |   | MEDICAID |