Provider Demographics
NPI:1992787386
Name:BEIRNE, DOUGLAS R (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:BEIRNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKE ARMY MEDICAL CENTER MCHE-QD/ CREDENTIALS
Mailing Address - Street 2:3851 ROGER BROOKE DR
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-5666
Mailing Address - Fax:
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER MCHE-QD/ CREDENTIALS
Practice Address - Street 2:3851 ROGER BROOKE DR
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-5666
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX792213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU11766Medicare UPIN