Provider Demographics
NPI:1043218431
Name:BEALL, JEFFREY K (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:BEALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 509
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-358-4007
Mailing Address - Fax:775-358-4405
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 509
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-358-4007
Practice Address - Fax:775-358-4405
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9426207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00G619810Medicaid
NV00G619810Medicaid
D35497Medicare UPIN