1740289016 NPI number — ROBERT E BEASLEY MD

Table of content: ROBERT E BEASLEY MD (NPI 1740289016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740289016 NPI number — ROBERT E BEASLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEASLEY
Provider First Name:
ROBERT
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740289016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 ALTON RD
Provider Second Line Business Mailing Address:
2ND FLOOR ASCHER BUILDING
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-674-2841
Provider Business Mailing Address Fax Number:
305-535-7919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 ALTON RD
Provider Second Line Business Practice Location Address:
DE HIRSCH MEYER TOWER, SUITE 1100
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-674-2071
Provider Business Practice Location Address Fax Number:
305-535-7983
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  ME48730 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0528960100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".