Provider Demographics
NPI:1356855456
Name:BEASLER, ALFRED MARION III (MHS PA-C)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:MARION
Last Name:BEASLER
Suffix:III
Gender:M
Credentials:MHS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-2642
Mailing Address - Country:US
Mailing Address - Phone:918-645-3747
Mailing Address - Fax:
Practice Address - Street 1:4802 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-2642
Practice Address - Country:US
Practice Address - Phone:918-645-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPA2832OtherOKLAHOMA MEDICAL BOARD