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General NPI Number Information
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NPI Number | 1306514807
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Entity Type | Organization
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Legal Business Name | GORDON J BEAN DPM INC
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 600 W 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3617
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Country | US
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Telephone | 405-340-9251
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Fax | 405-340-0686
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Provider Business Mailing Address
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Address Line | 3001 S TELEPHONE RD STE B
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City | MOORE
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State | OK
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Zip | 73160-2942
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Country | US
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Telephone | 405-794-6691
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Fax | 405-794-9856
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Authorized Official
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Title or Position | PODIATRIST
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Name | GORDON JAMES BEAN
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Credential | DPM
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Telephone | 405-794-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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