Healthcare Provider Details

I. General information

NPI: 1992757181
Provider Name (Legal Business Name): DOUGLAS P BEALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 WATERWOOD PKWY
EDMOND OK
73034-5324
US

IV. Provider business mailing address

PO BOX 1390
OKLAHOMA CITY OK
73101-1390
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-2325
  • Fax: 405-497-6074
Mailing address:
  • Phone: 405-601-2325
  • Fax: 405-497-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number19054
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number19054
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19054
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: