Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 9426 | NV |
NPI | 1043218431 |
---|---|
Provider Name | Jeffrey K Beall |
First Address | Reno, NV 89502-1464 |
Second Address | Reno, NV 89502-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 20/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G619810 | (05) | NV |
D35497 | (02) |