Individual provider · NPI-1

Dr. Matthew C. Bean, MD

Family Medicine · Coeur D Alene, ID

NPI number1053675009
StatusActive
Last updated in NPPESApr 15, 2024

Details

NPI
1053675009
Entity type
Individual (NPI-1)
Name
Dr. Matthew C. Bean
Credential
MD
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 25, 2012
Certification date
Apr 15, 2024
Last updated
Apr 15, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineM13757IDYes

Practice location

1919 Lincoln Way Ste 315
Coeur D Alene, ID 83814-2527

Phone 208-625-6000 · Fax 208-625-6001

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

Phone 208-625-5085 · Fax 208-625-5731

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