Provider Demographics
NPI:1316939622
Name:BEAM, CHESTER WRAY (MD)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:WRAY
Last Name:BEAM
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 1:2224 NW 50TH ST
Mailing Address - Street 2:STE 276W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8088
Mailing Address - Country:US
Mailing Address - Phone:405-486-7250
Mailing Address - Fax:706-653-8732
Practice Address - Street 1:2224 NW 50TH ST
Practice Address - Street 2:SUITE 276W
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8046
Practice Address - Country:US
Practice Address - Phone:405-858-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100134960AMedicaid
OKE28943Medicare UPIN
OKRADIG101Medicare PIN