Healthcare Provider Details

I. General information

NPI: 1679711410
Provider Name (Legal Business Name): DEBORAH S BEARCE P. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 HOSPITAL RD
HEALDTON OK
73438-6124
US

IV. Provider business mailing address

3462 HOSPITAL RD
HEALDTON OK
73438-6124
US

V. Phone/Fax

Practice location:
  • Phone: 580-229-0701
  • Fax: 580-229-1454
Mailing address:
  • Phone: 580-229-0701
  • Fax: 580-229-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1781
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: