Healthcare Provider Details

I. General information

NPI: 1063769479
Provider Name (Legal Business Name): PHILIP HARRIS BEARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SW 98TH ST
OKLAHOMA CITY OK
73139-8803
US

IV. Provider business mailing address

5 SW 98TH ST
OKLAHOMA CITY OK
73139-8803
US

V. Phone/Fax

Practice location:
  • Phone: 405-834-1000
  • Fax:
Mailing address:
  • Phone: 405-834-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90194
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: