Healthcare Provider Details

I. General information

NPI: 1124092960
Provider Name (Legal Business Name): ZACHARY T BECHTOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NEO LOOP STE A
GROVE OK
74344-6046
US

IV. Provider business mailing address

1121 NEO LOOP STE A
GROVE OK
74344-6046
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-4664
  • Fax: 918-786-4256
Mailing address:
  • Phone: 918-786-4664
  • Fax: 918-786-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20108
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20108
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: