Basic Information
Provider Information | |||||||||
NPI: | 1912935438 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEESON | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | PROF. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7350 | ||||||||
Address2: |   | ||||||||
City: | PASADENA | ||||||||
State: | TX | ||||||||
PostalCode: | 775087350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4059478585 | ||||||||
FaxNumber: | 4059486507 | ||||||||
Practice Location | |||||||||
Address1: | 3315 BURKE RD | ||||||||
Address2: | #300 | ||||||||
City: | PASADENA | ||||||||
State: | TX | ||||||||
PostalCode: | 775041827 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7139445151 | ||||||||
FaxNumber: | 4059486507 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/30/2006 | ||||||||
LastUpdateDate: | 04/17/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | J3279 | TX | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 10674347 | 01 | TX | PPO NEXT HHPO | OTHER | 082170F | 01 | TX | BC/BS | OTHER |