Healthcare Provider Details

I. General information

NPI: 1760693154
Provider Name (Legal Business Name): BRYANT R. BEEHLER, D.O., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3863 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2518
US

IV. Provider business mailing address

3863 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2518
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3738
  • Fax: 701-239-3738
Mailing address:
  • Phone: 701-239-3738
  • Fax: 701-239-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number27285
License Number StateMN

VIII. Authorized Official

Name: DR. BRYANT RICHARD BEEHLER
Title or Position: DOCTOR
Credential: D.O.
Phone: 701-239-3738