Healthcare Provider Details

I. General information

NPI: 1134165723
Provider Name (Legal Business Name): ROBERT B MCBEATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE 165
LAS VEGAS NV
89128-0462
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-0814
  • Fax: 702-877-3238
Mailing address:
  • Phone: 702-560-2916
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6974
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: