Healthcare Provider Details

I. General information

NPI: 1568428605
Provider Name (Legal Business Name): RODOLFO SCOTT BEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 STATE ROUTE 159
GLEN CARBON IL
62034
US

IV. Provider business mailing address

9 KINGSLEY WAY
GLEN CARBON IL
62034-1554
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-2970
  • Fax: 618-288-3572
Mailing address:
  • Phone: 618-288-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036140919
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: