Provider Demographics
NPI:1720274376
Name:BEAMAN, JASON WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WALTER
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 E 31ST ST FL 13
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5018
Mailing Address - Country:US
Mailing Address - Phone:918-561-5701
Mailing Address - Fax:918-561-1173
Practice Address - Street 1:5310 E 31ST ST FL LL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5018
Practice Address - Country:US
Practice Address - Phone:918-236-4000
Practice Address - Fax:918-236-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4615207Q00000X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK304297YM2YOtherMEDICARE
OK200207470AMedicaid