Healthcare Provider Details

I. General information

NPI: 1144299587
Provider Name (Legal Business Name): ROBERT ALAN BEASLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 NORTH JACKSON STREET SUITE 150
TULLAHOMA TN
37388
US

IV. Provider business mailing address

102 DUNHILL PLACE
CLEVELAND TN
37311
US

V. Phone/Fax

Practice location:
  • Phone: 931-563-8003
  • Fax:
Mailing address:
  • Phone: 423-472-1567
  • Fax: 423-476-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD011102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: