Healthcare Provider Details

I. General information

NPI: 1982881173
Provider Name (Legal Business Name): GORDON J BEAN DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S TELEPHONE RD STE B
MOORE OK
73160-5424
US

IV. Provider business mailing address

3001 S TELEPHONE RD STE B
MOORE OK
73160-5424
US

V. Phone/Fax

Practice location:
  • Phone: 405-794-6691
  • Fax: 405-794-9856
Mailing address:
  • Phone: 405-794-6691
  • Fax: 405-794-9856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number185
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number185
License Number StateOK

VIII. Authorized Official

Name: DR. GORDON JAMES BEAN
Title or Position: PROVIDER
Credential: DPM
Phone: 405-794-6691