Basic Information
| Provider Information | |||||||||
| NPI: | 1578953378 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BEER | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3926 NEW VISION DR | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746583500 | ||||||||
| FaxNumber: | 5746583501 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 DUBOIS DR | ||||||||
| Address2: | |||||||||
| City: | WARSAW | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465803213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742676778 | ||||||||
| FaxNumber: | 5742673134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2015 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10001808A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.