Provider Demographics
NPI:1437172723
Name:BEESON, ROBERT CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARK
Last Name:BEESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1210 MEDICAL ARTS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3437
Mailing Address - Country:US
Mailing Address - Phone:765-298-4100
Mailing Address - Fax:765-298-4988
Practice Address - Street 1:1210 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4100
Practice Address - Fax:765-298-4988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01028543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01028543OtherSTATE LICENSE NUMBER
IND95787Medicare UPIN
IN522480Medicare ID - Type Unspecified