Individual
SEAN DALY BEATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4101 WAGON TRAIL AVE, LAS VEGAS, NV 89118-4426
(702) 942-4123
(702) 942-4124
Mailing address
1 INDEPENDENCE PT STE 202, GREENVILLE, SC 29615-4536
(877) 406-2916
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
11844
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100509912
—
NV
01
—
86080015085259A463
TRICARE WEST
AZ
05
—
939788
—
AZ
01
—
CC4853
BLUE
NV
01
—
P00342670
RR MEDICARE
NV
Enumeration date
11/28/2005
Last updated
01/11/2013
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