Provider Demographics
NPI:1093879645
Name:JEFFREY K BEALL MD LLC
Entity Type:Organization
Organization Name:JEFFREY K BEALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-358-4007
Mailing Address - Street 1:75 PRINGLE WAY STE 509
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1469
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35992207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD35497Medicare UPIN