Healthcare Provider Details

I. General information

NPI: 1255334967
Provider Name (Legal Business Name): GORDON JAMES BEAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
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 ROAD 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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number185
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: