Healthcare Provider Details

I. General information

NPI: 1972710168
Provider Name (Legal Business Name): ROBERT ESTEP BEVERLY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 ADOBE CT
VIRGINIA BEACH VA
23456-4924
US

IV. Provider business mailing address

USS BARRY DDG 52 MEDICAL DEPARTMENT
FPO AE
09565
US

V. Phone/Fax

Practice location:
  • Phone: 757-227-3149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: