Healthcare Provider Details

I. General information

NPI: 1609957778
Provider Name (Legal Business Name): ANTHONY IVAN BEUTLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE ROAD FAP/A-1038/UNIFORMED SERVICES UNIVERSITY
BETHESDA MD
20814-4712
US

IV. Provider business mailing address

4301 JONES BRIDGE ROAD FAP/A-1038/UNIFORMED SERVICES UNIVERSITY
BETHESDA MD
20814-4712
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-3632
  • Fax: 301-295-3100
Mailing address:
  • Phone: 301-295-3632
  • Fax: 301-295-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01052416A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: