Provider Demographics
NPI:1396765871
Name:BEUS, KIRT SCOTT (MD)
Entity type:Individual
Prefix:
First Name:KIRT
Middle Name:SCOTT
Last Name:BEUS
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 1:1055 N 300 W
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3344
Mailing Address - Country:US
Mailing Address - Phone:801-357-7499
Mailing Address - Fax:801-373-5980
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:SUITE 401
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3306
Practice Address - Country:US
Practice Address - Phone:801-357-7499
Practice Address - Fax:801-373-5980
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25626207Y00000X
UT6959601-1205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR45305Medicare ID - Type Unspecified
UT000065812Medicare PIN
ORI24202Medicare UPIN