Basic Information
| Provider Information | |||||||||
| NPI: | 1518939982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEITZEL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 S CRESCENT DR | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414945400 | ||||||||
| FaxNumber: | 6414945403 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S CRESCENT DR | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414945260 | ||||||||
| FaxNumber: | 6414945267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 10637 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 001335 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 085006091 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.