Provider Demographics
NPI:1477882413
Name:ROBERT W BEART, JR., M.D., INC
Entity Type:Organization
Organization Name:ROBERT W BEART, JR., M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-8161
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-244-8161
Mailing Address - Fax:818-244-5122
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-244-8161
Practice Address - Fax:818-244-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty