Provider Demographics
NPI:1144217753
Name:HEASTY, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:HEASTY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0615
Mailing Address - Country:US
Mailing Address - Phone:308-632-7322
Mailing Address - Fax:308-632-6181
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0615
Practice Address - Country:US
Practice Address - Phone:308-632-7322
Practice Address - Fax:308-632-6181
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE130222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEE28880Medicare UPIN