Provider Demographics
NPI:1790700466
Name:BEARD, LOIS S (DO)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:S
Last Name:BEARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 S BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7304
Mailing Address - Country:US
Mailing Address - Phone:918-607-6533
Mailing Address - Fax:918-615-6963
Practice Address - Street 1:2605 S BEECH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7304
Practice Address - Country:US
Practice Address - Phone:918-607-6533
Practice Address - Fax:918-615-6963
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522545OtherMEDICARE ID NUMBER
OK100203570CMedicaid
OK100203570CMedicaid
OK400522545OtherMEDICARE ID NUMBER
OKOKB5391Medicare PIN