Provider Demographics
NPI:1871686428
Name:SOUTHBROOK FAMILY PHYSICIANS PLLC
Entity Type:Organization
Organization Name:SOUTHBROOK FAMILY PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEYMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-459-0027
Mailing Address - Street 1:8803 S. 101ST E. AVE.
Mailing Address - Street 2:SUITE #130
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5728
Mailing Address - Country:US
Mailing Address - Phone:918-459-0027
Mailing Address - Fax:918-250-0457
Practice Address - Street 1:8803 S. 101ST E. AVE.
Practice Address - Street 2:SUITE #130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5728
Practice Address - Country:US
Practice Address - Phone:918-459-0027
Practice Address - Fax:918-250-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522067Medicare ID - Type Unspecified