Individual
SAMUEL ISAAC BETHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1071 W BLUE STARR DR STE 105, CLAREMORE, OK 74017-2869
(918) 361-0600
(918) 927-3201
Mailing address
2488 E 81ST ST STE 290, TULSA, OK 74137-4265
(918) 927-3226
(918) 927-3193
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2431
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200570050A
—
OK
Enumeration date
01/02/2015
Last updated
02/23/2022
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