Healthcare Provider Details

I. General information

NPI: 1508002775
Provider Name (Legal Business Name): KEITH ALLAN BEIERMEISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 201
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-2272
  • Fax: 858-558-2285
Mailing address:
  • Phone: 858-558-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA125321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: