Healthcare Provider Details

I. General information

NPI: 1144474362
Provider Name (Legal Business Name): ARTHUR DOUGLAS BEACHAM III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BROADWAY EXT STE 203
OKLAHOMA CITY OK
73114-6304
US

IV. Provider business mailing address

9800 BROADWAY EXT STE 203
OKLAHOMA CITY OK
73114-6304
US

V. Phone/Fax

Practice location:
  • Phone: 405-424-5415
  • Fax: 405-424-5416
Mailing address:
  • Phone: 405-424-5415
  • Fax: 405-424-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5351
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: