Provider Demographics
NPI:1538188586
Name:BEATY, RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:BEATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3407
Mailing Address - Country:US
Mailing Address - Phone:205-802-2000
Mailing Address - Fax:205-802-2012
Practice Address - Street 1:3686 GRANDVIEW PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3407
Practice Address - Country:US
Practice Address - Phone:205-802-2000
Practice Address - Fax:205-802-2012
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL14075207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73034Medicare UPIN
AL000089414Medicare ID - Type Unspecified