Healthcare Provider Details

I. General information

NPI: 1124939186
Provider Name (Legal Business Name): ADAM JOHN BEYER SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W 7TH ST
WRAY CO
80758-1420
US

IV. Provider business mailing address

1017 W 7TH ST
WRAY CO
80758-1420
US

V. Phone/Fax

Practice location:
  • Phone: 970-332-4811
  • Fax:
Mailing address:
  • Phone: 720-879-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA.0003043
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: