MEDICARE: ROBERT C DEAL M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program	13316	NV

General Provider Information

NPI Number	:	1215118245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C DEAL M.D.

Provider Business Mailing Address
First Line	:	4432 8TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35222-4413
Country	:	US
Telephone Number	:	205-266-1791
Fax Number	:

Provider Business Practice Location Address
First Line	:	8871 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5865
Country	:	US
Telephone Number	:	205-266-1791
Fax Number	:

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	04/30/2010

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