Healthcare Provider Details

I. General information

NPI: 1043218431
Provider Name (Legal Business Name): JEFFREY K BEALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY SUITE 509
RENO NV
89502-1464
US

IV. Provider business mailing address

75 PRINGLE WAY SUITE 509
RENO NV
89502-1464
US

V. Phone/Fax

Practice location:
  • Phone: 775-358-4007
  • Fax: 775-358-4405
Mailing address:
  • Phone: 775-358-4007
  • Fax: 775-358-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9426
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: