Provider Demographics
NPI:1255334967
Name:BEAN, GORDON JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:JAMES
Last Name:BEAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:3001 S TELEPHONE ROAD
Mailing Address - Street 2:STE B
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5424
Mailing Address - Country:US
Mailing Address - Phone:405-794-6691
Mailing Address - Fax:405-794-9856
Practice Address - Street 1:3001 S TELEPHONE RD
Practice Address - Street 2:STE B
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5424
Practice Address - Country:US
Practice Address - Phone:405-794-6691
Practice Address - Fax:405-794-9856
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK185213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA103503Medicare PIN
OK480019156Medicare PIN
OK1020120001Medicare NSC
OKU55243Medicare UPIN