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General NPI Number Information
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NPI Number | 1881170520
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Entity Type | Organization
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Legal Business Name | BEAIR MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 201 W. MAIN STREET SUITE 101
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City | JENKS
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State | OK
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Zip | 74037
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Country | US
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Telephone | 918-809-6952
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 W 117TH ST S
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City | JENKS
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State | OK
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Zip | 74037-4348
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Country | US
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Telephone | 918-809-6952
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. KARA MARIE BEAIR BUTLER
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Credential | DO
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Telephone | 918-809-6952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1172
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5195
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5195
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License Number State | OK
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