| Blue Bayou Inc | |
|
100 Park Ave Oklahoma City OK 73102-8006 | |
| (405) 229-3410 | |
| Not Available |
| Full Name | Blue Bayou Inc |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 100 Park Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | James Bronson (CEO) |
| Authorized Official Contact | 4052293410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Bayou Inc 100 Park Ave Oklahoma City OK 73102-8006 Ph: (405) 229-3410 | Blue Bayou Inc 100 Park Ave Oklahoma City OK 73102-8006 Ph: (405) 229-3410 |
| NPI Number | 1043568538 |
|---|---|
| Provider Enumeration Date | 08/15/2012 |
| Last Update Date | 09/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043568538 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | 12345 (Oklahoma) | Primary |
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