Provider Demographics
NPI:1346224821
Name:BEIER, RAFAEL L (DO)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:L
Last Name:BEIER
Suffix:
Gender:M
Credentials:DO
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 945
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-0945
Mailing Address - Country:US
Mailing Address - Phone:208-682-2151
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:PINEHUSRT
Practice Address - State:ID
Practice Address - Zip Code:83850-0945
Practice Address - Country:US
Practice Address - Phone:208-682-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H37801Medicare UPIN
1302212Medicare ID - Type Unspecified