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NPI Code Detail

MEDICARE: DR. JOHN E BEAVERS MD

MEDICARE: DR. JOHN E BEAVERS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician18578OK
2207Q00000XFamily Medicine Physician18578OK

General Provider Information

NPI Number : 1386615839
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN E BEAVERS MD
Provider Business Mailing Address
First Line : PO BOX 892410
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73189-2410
Country : US
Telephone Number : 405-735-9348
Fax Number : 405-703-3116
Provider Business Practice Location Address
First Line : 7530 NW 23RD ST
Second Line :
City : BETHANY
State : OK
Zip : 73008-4921
Country : US
Telephone Number : 405-730-6990
Fax Number : 405-703-3116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 05/12/2020

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