Healthcare Provider Details

I. General information

NPI: 1427044015
Provider Name (Legal Business Name): RICK D BELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 RENAISSANCE BLVD SUITE 100
EDMOND OK
73013-3084
US

IV. Provider business mailing address

720 S. COLORADO BLVD SUITE 220A
GLENDALE CO
80246-1912
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-3434
  • Fax: 405-341-9429
Mailing address:
  • Phone: 405-348-3434
  • Fax: 405-341-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number10007
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10007
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: