Healthcare Provider Details

I. General information

NPI: 1093829327
Provider Name (Legal Business Name): GARY E BEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 PARK BLVD
OAKLAND CA
94602
US

IV. Provider business mailing address

4180 PARK BLVD
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-530-5437
  • Fax: 510-530-9703
Mailing address:
  • Phone: 510-530-5437
  • Fax: 510-530-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG53663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: