Provider Demographics
NPI:1477584043
Name:MCBEATH, JO KENT (MD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:KENT
Last Name:MCBEATH
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 1:3121 S MARYLAND PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-320-3627
Mailing Address - Fax:702-320-3849
Practice Address - Street 1:3121 S MARYLAND PKWY
Practice Address - Street 2:STE 216
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109
Practice Address - Country:US
Practice Address - Phone:702-320-3852
Practice Address - Fax:702-320-3856
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0020023142Medicaid
NV32652Medicare ID - Type Unspecified
C96322Medicare UPIN