MEDICARE: ROBERT TERRY BECKSTEAD 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	207P00000X	Emergency Medicine Physician	M4339	ID
2	207P00000X	Emergency Medicine Physician	8115391-1205	UT

General Provider Information

NPI Number	:	1972531374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT TERRY BECKSTEAD M.D.

Provider Business Mailing Address
First Line	:	1626 E 6520 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2555
Country	:	US
Telephone Number	:	208-705-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 EAST 6520 SOUTH
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-2555
Country	:	US
Telephone Number	:	208-239-1000
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/01/2012

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