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General NPI Number Information
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NPI Number | 1871686428
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Entity Type | Organization
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Legal Business Name | SOUTHBROOK FAMILY PHYSICIANS PLLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 8803 S. 101ST E. AVE. SUITE #130
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City | TULSA
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State | OK
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Zip | 74133-5728
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Country | US
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Telephone | 918-459-0027
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Fax | 918-250-0457
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Provider Business Mailing Address
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Address Line | 8803 S. 101ST E. AVE. SUITE #130
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City | TULSA
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State | OK
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Zip | 74133-5728
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Country | US
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Telephone | 918-459-0027
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Fax | 918-250-0457
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAMES R BEYMER
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Credential | D.O.
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Telephone | 918-459-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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