Provider Demographics
NPI:1659879856
Name:GOETZ, BETH A (CPT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:GOETZ
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N LINCOLN BLVD STE 1308
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3252
Mailing Address - Country:US
Mailing Address - Phone:405-421-2959
Mailing Address - Fax:405-271-2836
Practice Address - Street 1:1000 N LINCOLN BLVD STE 1308
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-421-2959
Practice Address - Fax:405-271-2836
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK647679OtherMEDICARE DIABETIC PREVENTION PROGRAM