Provider Demographics
NPI:1386618197
Name:BEYER, JERRY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALAN
Last Name:BEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2408
Mailing Address - Country:US
Mailing Address - Phone:210-485-1850
Mailing Address - Fax:210-493-9500
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:210-485-1850
Practice Address - Fax:210-493-9500
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5455207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116644904Medicaid
TX8W650OtherBLUE CROSS BLUE SHIELD
TX8F4314Medicare PIN