Healthcare Provider Details

I. General information

NPI: 1548235948
Provider Name (Legal Business Name): FRANK L BLEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 W DEYOUNG ST SUITE 100
MARION IL
62959-5896
US

IV. Provider business mailing address

1000 E CHERRY ST
TROY MO
63379-1513
US

V. Phone/Fax

Practice location:
  • Phone: 618-998-7600
  • Fax: 618-997-6680
Mailing address:
  • Phone: 636-528-3348
  • Fax: 636-528-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR1F26
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR1F26
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036068299
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: