Blue Bayou INC
NPI #1043568538 in Oklahoma City, Oklahoma
Provider Information
- NPI Number
- 1043568538
- Entity Type
- Organization
- Organization Name
- Blue Bayou INC
- Primary Specialty
- Family Medicine - Adolescent Medicine
- Enumeration Date
- Aug 15, 2012
- Last Updated
- Sep 18, 2012
Practice Location
- Address
- 100 PARK AVE
- City
- Oklahoma City
- State
- Oklahoma
- ZIP Code
- 73102-8006
- Phone
- (405) 229-3410
Authorized Official
- Name
- JAMES BRONSON
- Title
- CEO
- Phone
- (405) 229-3410
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine - Adolescent Medicine — Adolescent Medicine |
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