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General NPI Number Information
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NPI Number | 1629020995
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Entity Type | Organization
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Legal Business Name | MUSCULOSKELETAL IMAGING AND INTERVENTIONAL LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1023 WATERWOOD PKWY
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City | EDMOND
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State | OK
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Zip | 73034-5324
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Country | US
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Telephone | 405-601-2325
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Fax | 405-497-6074
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Provider Business Mailing Address
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Address Line | PO BOX 1390
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-1390
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Country | US
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Telephone | 405-601-2325
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Fax | 405-497-6074
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Authorized Official
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Title or Position | CHIEF OF SERVICES
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Name | DOUGLAS P BEALL
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Credential | MD
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Telephone | 405-601-2325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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