Healthcare Provider Details

I. General information

NPI: 1740500164
Provider Name (Legal Business Name): BRENT A BESON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S WESTERN AVE 5000
OKLAHOMA CITY OK
73109-3447
US

IV. Provider business mailing address

4221 S WESTERN AVE 5000
OKLAHOMA CITY OK
73109-3447
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-5160
  • Fax: 405-644-5162
Mailing address:
  • Phone: 405-644-5160
  • Fax: 405-644-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number23752
License Number StateOK

VIII. Authorized Official

Name: DR. BRENT A BESON
Title or Position: PHYSICIAN
Credential: MD
Phone: 405-644-5160