Provider Demographics
NPI:1992792113
Name:BEAHRS, JOHN RANDOLF (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDOLF
Last Name:BEAHRS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1712
Mailing Address - Country:US
Mailing Address - Phone:651-999-6909
Mailing Address - Fax:651-999-6830
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1712
Practice Address - Country:US
Practice Address - Phone:651-999-6909
Practice Address - Fax:651-999-6830
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-09-10
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Provider Licenses
StateLicense IDTaxonomies
MN23471208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340008162OtherRR MEDICARE
MN547803100Medicaid
MN340008162OtherRR MEDICARE
MNA96357Medicare UPIN