Provider Demographics
NPI:1992757181
Name:BEALL, DOUGLAS P (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:BEALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1390
Mailing Address - Country:US
Mailing Address - Phone:405-601-2325
Mailing Address - Fax:405-497-6074
Practice Address - Street 1:1023 WATERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5324
Practice Address - Country:US
Practice Address - Phone:405-601-2325
Practice Address - Fax:405-497-6074
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190542085R0204X, 208VP0014X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200005010AMedicaid
P00371184Medicare PIN
OK200005010AMedicaid
OK243615201Medicare PIN