Provider Demographics
NPI:1083673008
Name:BEESBURG, ROBERT Y (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:Y
Last Name:BEESBURG
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:PO BOX 90824
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-1824
Mailing Address - Country:US
Mailing Address - Phone:803-312-2591
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:2435 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2026
Practice Address - Country:US
Practice Address - Phone:803-865-4780
Practice Address - Fax:803-865-4932
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16948207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL8131Medicaid
SCF647557682Medicare PIN
SCTL8131Medicaid
SCF647553662Medicare PIN