Provider Demographics
NPI:1740289016
Name:BEASLEY, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BEASLEY
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 1:4300 ALTON RD
Mailing Address - Street 2:2ND FLOOR ASCHER BUILDING
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2948
Mailing Address - Country:US
Mailing Address - Phone:305-674-2841
Mailing Address - Fax:305-535-7919
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:DE HIRSCH MEYER TOWER, SUITE 1100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-674-2071
Practice Address - Fax:305-535-7983
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME487302085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0528960100Medicaid
FL09188YMedicare ID - Type Unspecified
FL0528960100Medicaid