Provider Demographics
NPI:1023346806
Name:BEAMON, SHELBY MATTHIAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:SHELBY
Middle Name:MATTHIAS
Last Name:BEAMON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-8301
Mailing Address - Country:US
Mailing Address - Phone:405-271-5859
Mailing Address - Fax:405-607-0655
Practice Address - Street 1:2600 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-8301
Practice Address - Country:US
Practice Address - Phone:405-271-5859
Practice Address - Fax:405-607-0655
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAPA1859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant