Individual
DR. JACK JUAN BELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3301 NW 50TH ST, OKLAHOMA CITY, OK 73112-5627
(405) 947-0911
Mailing address
3301 NW 50TH ST, OKLAHOMA CITY, OK 73112-5627
(405) 947-0911
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9412
OK
207X00000X
Orthopaedic Surgery Physician
9412
OK
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
9412
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110450A
—
OK
01
—
P00777384
MCR RAILROAD
OK
Enumeration date
07/13/2005
Last updated
09/07/2012
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