Provider Demographics
NPI:1104897594
Name:BEERY, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:BEERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:OSLER MEDICAL CENTER
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-6633
Mailing Address - Fax:937-393-8588
Practice Address - Street 1:219 W MAIN ST.
Practice Address - Street 2:OSLER MEDICAL CENTER
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-6633
Practice Address - Fax:937-393-8588
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH63290207R00000X
OH35-063290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0857112Medicaid
OH0857112Medicaid
266169Medicare UPIN
OHE66169Medicare UPIN