Provider Demographics
NPI:1568490134
Name:ANTONIO BELTRAN M.D. PA
Entity Type:Organization
Organization Name:ANTONIO BELTRAN M.D. PA
Other - Org Name:STUART UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-872-6120
Mailing Address - Street 1:2220 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3301
Mailing Address - Country:US
Mailing Address - Phone:772-872-6120
Mailing Address - Fax:772-872-6165
Practice Address - Street 1:2220 SE OCEAN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-872-6120
Practice Address - Fax:772-872-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6900Medicare PIN