Provider Demographics
NPI:1386796738
Name:BEATTIE, ROBERT S (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-517 HONOKOHAU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2715
Mailing Address - Country:US
Mailing Address - Phone:808-334-4400
Mailing Address - Fax:
Practice Address - Street 1:74-517 HONOKOHAU ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2715
Practice Address - Country:US
Practice Address - Phone:808-334-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12572363A00000X
HIAMD-60363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant