Healthcare Provider Details

I. General information

NPI: 1972718658
Provider Name (Legal Business Name): BARRY BEUTLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MARTHA AVE STE B
IDAHO FALLS ID
83404-7580
US

IV. Provider business mailing address

1975 MARTHA AVE STE B
IDAHO FALLS ID
83404-7580
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-4598
  • Fax: 208-529-3915
Mailing address:
  • Phone: 208-522-4598
  • Fax: 208-529-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR-9048
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT187835
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8973A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM-12141
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9063
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8622635-1205
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301091543
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMED-PHYS-LIC-29693
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: