MEDICARE: BEAUTY THRU HEALTH DERMATOLOGY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	12980	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300522112	OTHER	OK	MEDICARE PTAN

General Provider Information

NPI Number	:	1245447218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTY THRU HEALTH DERMATOLOGY, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 2074
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-2074
Country	:	US
Telephone Number	:	405-278-7911
Fax Number	:	405-278-7925

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 407
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2425
Country	:	US
Telephone Number	:	405-278-7911
Fax Number	:	405-278-7925

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLARENCE LAPIERCE WILEY SR.
Credential	:	M.D.
Telephone Number	:	405-278-7911

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/04/2016

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Directions to “BEAUTY THRU HEALTH DERMATOLOGY, P.C. ” Practice Location

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