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NPI Code Detail

MEDICARE: DR. ROBERTA BEALS DO

MEDICARE: DR. ROBERTA BEALS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianJ7424TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013988211
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERTA BEALS DO
Provider Business Mailing Address
First Line : 4724 N DAVIS HWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-2339
Country : US
Telephone Number : 850-696-4000
Fax Number : 850-434-2647
Provider Business Practice Location Address
First Line : 161 E NINE MILE RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32534-3140
Country : US
Telephone Number : 850-696-4000
Fax Number : 850-434-2647
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 06/17/2024

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Directions to “ DR. ROBERTA BEALS DO” Practice Location

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