Provider Demographics
NPI:1316912306
Name:BEERS, RICHARD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:BEERS
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 1:3535 SOUTHERN BLVD
Mailing Address - Street 2:DEPT OF PMR
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1298
Mailing Address - Country:US
Mailing Address - Phone:937-395-8666
Mailing Address - Fax:937-297-8090
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:DEPT OF PMR
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1298
Practice Address - Country:US
Practice Address - Phone:937-395-8666
Practice Address - Fax:937-297-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0768-B208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609809Medicaid
OH0609809Medicaid
OH250013343Medicare PIN
OH0630271Medicare PIN