Provider Demographics
NPI:1518223593
Name:BESWICK DERMATOLOGY PC
Entity Type:Organization
Organization Name:BESWICK DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:CLYNE
Authorized Official - Last Name:BESWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:214-207-7063
Mailing Address - Street 1:332 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5116
Mailing Address - Country:US
Mailing Address - Phone:214-207-7063
Mailing Address - Fax:
Practice Address - Street 1:3915 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3605
Practice Address - Country:US
Practice Address - Phone:918-749-5714
Practice Address - Fax:918-749-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27111207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty