Provider Demographics
NPI:1982881173
Name:GORDON J BEAN DPM INC
Entity Type:Organization
Organization Name:GORDON J BEAN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-794-6691
Mailing Address - Street 1:3001 S TELEPHONE RD
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK185213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55243Medicare UPIN
480019156Medicare PIN
OK1020120001Medicare NSC
OKOKA103502Medicare PIN