Provider Demographics
NPI:1124092960
Name:BECHTOL, ZACHARY T (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:T
Last Name:BECHTOL
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 1:1121 NEO LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6046
Mailing Address - Country:US
Mailing Address - Phone:918-786-4664
Mailing Address - Fax:918-786-4256
Practice Address - Street 1:1121 NEO LOOP STE A
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6046
Practice Address - Country:US
Practice Address - Phone:918-786-4664
Practice Address - Fax:918-786-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20108207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20108OtherSTATE LICENSE NUMBER
OK100253510AMedicaid
OK244533502OtherMEDICARE/IGGHER INDIVIDUAL
OK37D0961847OtherCLIA
OK20108OtherSTATE LICENSE NUMBER
OK080145239OtherMEDICARE RAILROAD
OK400522511OtherMEDICARE/IGGH/ER DR GROUP
73-1565181OtherFEDERAL TAX ID NUMBER
OK100253510AMedicaid
OK080145239OtherMEDICARE RAILROAD