Provider Demographics
NPI:1245719046
Name:BEAL, JASON ROBERT
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:BEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 RIZLEY RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-9185
Mailing Address - Country:US
Mailing Address - Phone:405-566-9314
Mailing Address - Fax:
Practice Address - Street 1:5040 RIZLEY RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-9185
Practice Address - Country:US
Practice Address - Phone:405-566-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist