MEDICARE: JEFFREY K BEALL MD

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
1	207Y00000X	Otolaryngology Physician	9426	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1043218431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY K BEALL MD

Provider Business Mailing Address
First Line	:	75 PRINGLE WAY
Second Line	:	SUITE 509
City	:	RENO
State	:	NV
Zip	:	89502-1464
Country	:	US
Telephone Number	:	775-358-4007
Fax Number	:	775-358-4405

Provider Business Practice Location Address
First Line	:	75 PRINGLE WAY
Second Line	:	SUITE 509
City	:	RENO
State	:	NV
Zip	:	89502-1464
Country	:	US
Telephone Number	:	775-358-4007
Fax Number	:	775-358-4405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	12/20/2012

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