Provider Demographics
NPI:1215918792
Name:BELT, JAY C (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:BELT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 N INTERSTATE DR
Mailing Address - Street 2:SUITE 154
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3376
Mailing Address - Country:US
Mailing Address - Phone:405-247-6685
Mailing Address - Fax:405-247-2043
Practice Address - Street 1:1104 E CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4400
Practice Address - Country:US
Practice Address - Phone:405-247-6685
Practice Address - Fax:405-247-2043
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089030AMedicaid
080127758Medicare PIN
D42534Medicare UPIN
OK100089030AMedicaid