Provider Demographics
NPI:1427044015
Name:BELLER, RICK D (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:BELLER
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 1:720 S. COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:405-348-3434
Mailing Address - Fax:405-341-9429
Practice Address - Street 1:1701 RENAISSANCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3084
Practice Address - Country:US
Practice Address - Phone:405-348-3434
Practice Address - Fax:405-341-9429
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10007207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100122800AMedicaid
OK400522439OtherMEDICARE GROUP NUMBER
OK100122800AMedicaid
OK244509802Medicare PIN