Healthcare Provider Details

I. General information

NPI: 1548266620
Provider Name (Legal Business Name): CYNTHIA ANN BEAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE STE 304
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

PO BOX 15730
LOVES PARK IL
61132-5730
US

V. Phone/Fax

Practice location:
  • Phone: 815-964-3333
  • Fax: 815-964-3331
Mailing address:
  • Phone: 815-864-3333
  • Fax: 815-864-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: