Provider Demographics
NPI:1992724645
Name:BEALE, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BEALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 OLD SYMSONIA ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5042
Mailing Address - Country:US
Mailing Address - Phone:270-527-7400
Mailing Address - Fax:270-527-2211
Practice Address - Street 1:619 OLD SYMSONIA ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5042
Practice Address - Country:US
Practice Address - Phone:270-527-7400
Practice Address - Fax:270-527-2211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYKY32012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00386601OtherRR MEDICARE
KY000000386630OtherBLUE CROSS AND BLUE SHIEL
KY000000056871OtherBLUE CROSS & BLUE SHIELD
KY020030282OtherRR MEDICARE
KY64320120Medicaid
KY64320120Medicaid
KY020030282OtherRR MEDICARE
KYF80672Medicare UPIN