Healthcare Provider Details

I. General information

NPI: 1023223849
Provider Name (Legal Business Name): ROBERT LEROY BELT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31561 TABLE ROCK DR UNIT 108
LAGUNA BEACH CA
92651
US

IV. Provider business mailing address

31561 TABLE ROCK DR UNIT 108
LAGUNA BEACH CA
92651
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-4950
  • Fax:
Mailing address:
  • Phone: 949-499-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberAFE16947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: