Provider Demographics
NPI:1609894419
Name:BEETS, BILLY C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:C
Last Name:BEETS
Suffix:JR
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 400
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0400
Mailing Address - Country:US
Mailing Address - Phone:918-756-3334
Mailing Address - Fax:918-756-3993
Practice Address - Street 1:800 W FORREST AVE
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3249
Practice Address - Country:US
Practice Address - Phone:918-689-2547
Practice Address - Fax:918-756-3993
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21208207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1121208Medicaid
H00931Medicare UPIN