Healthcare Provider Details

I. General information

NPI: 1164413209
Provider Name (Legal Business Name): MARK ALLEN BEERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 C AVE E
OSKALOOSA IA
52577-4246
US

IV. Provider business mailing address

1229 C AVE E
OSKALOOSA IA
52577-4246
US

V. Phone/Fax

Practice location:
  • Phone: 641-672-3360
  • Fax: 641-672-9262
Mailing address:
  • Phone: 641-672-3360
  • Fax: 641-672-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number502
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: