Provider Demographics
NPI:1447264122
Name:BEATTY, ROBERT M (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:BEATTY
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 1:3800 W 57TH TER
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3401
Mailing Address - Country:US
Mailing Address - Phone:913-558-1539
Mailing Address - Fax:
Practice Address - Street 1:3800 W 57TH TER
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-3401
Practice Address - Country:US
Practice Address - Phone:913-904-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU4976207T00000X
OH35C.000191207T00000X
KS0420675207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18398069OtherBCBS KANSAS CITY
KS101860OtherBCBS KANSAS
MO202548814Medicaid
KS100122740BMedicaid
KSB74197Medicare UPIN
KS100122740BMedicaid
MO202548814Medicaid