Provider Demographics
NPI:1386615839
Name:BEAVERS, JOHN E (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 892410
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-2410
Mailing Address - Country:US
Mailing Address - Phone:405-735-9348
Mailing Address - Fax:405-703-3116
Practice Address - Street 1:7530 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4921
Practice Address - Country:US
Practice Address - Phone:405-730-6990
Practice Address - Fax:405-703-3116
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK18578208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF87634Medicare UPIN
OK37D1085195OtherCLIA
OK4466645796RMedicare PIN
OK370021415OtherRAILROAD MEDICARE
OK100125120BMedicaid