Healthcare Provider Details

I. General information

NPI: 1851785265
Provider Name (Legal Business Name): JUSTIN BEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 S WILLIAMSON BLVD
PORT ORANGE FL
32128-6101
US

IV. Provider business mailing address

PO BOX 9430
DAYTONA BEACH FL
32120-9430
US

V. Phone/Fax

Practice location:
  • Phone: 321-480-4589
  • Fax:
Mailing address:
  • Phone: 321-480-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME135074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: