Healthcare Provider Details

I. General information

NPI: 1477882413
Provider Name (Legal Business Name): ROBERT W BEART, JR., M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EULALIA ST SUITE 100A
GLENDALE CA
91204-2849
US

IV. Provider business mailing address

222 W EULALIA ST SUITE 100A
GLENDALE CA
91204-2849
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-8161
  • Fax: 818-244-5122
Mailing address:
  • Phone: 818-244-8161
  • Fax: 818-244-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG76196
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT W BEART JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-244-8161