Healthcare Provider Details

I. General information

NPI: 1508128216
Provider Name (Legal Business Name): DR. JAMES STEPHEN BECK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 06/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 PINE DR
GROVE OK
74344-5503
US

IV. Provider business mailing address

1639 PINE DR
GROVE OK
74344-5503
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-6944
  • Fax: 918-787-8661
Mailing address:
  • Phone: 918-786-6944
  • Fax: 918-787-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number17224
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: