Provider Demographics
NPI:1700886280
Name:BEVILL, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:BEVILL
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 1:111 E KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-8022
Mailing Address - Country:US
Mailing Address - Phone:309-446-3305
Mailing Address - Fax:309-446-9072
Practice Address - Street 1:111 E KNOXVILLE ST
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:IL
Practice Address - Zip Code:61517-8022
Practice Address - Country:US
Practice Address - Phone:309-446-3305
Practice Address - Fax:309-446-9072
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069-231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-069-231Medicaid
ILK37812Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
C48132Medicare UPIN