Provider Demographics
NPI:1235138314
Name:BEASLEY, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8132
Mailing Address - Country:US
Mailing Address - Phone:405-951-3732
Mailing Address - Fax:405-951-3916
Practice Address - Street 1:701 MARKET DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8132
Practice Address - Country:US
Practice Address - Phone:405-951-3732
Practice Address - Fax:405-951-3916
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF04855Medicare UPIN
OK8HZ171Medicare ID - Type UnspecifiedPART B