Provider Demographics
NPI:1992757181
Name:BEALL, DOUGLAS P (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:BEALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1390
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:1700 S STATE ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3633
Practice Address - Country:US
Practice Address - Phone:405-341-6410
Practice Address - Fax:405-348-0423
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK190542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200005010AMedicaid
P00371184Medicare PIN
OK200005010AMedicaid
OK243615201Medicare PIN