Provider Demographics
NPI:1013387810
Name:BDC MEDICAL, PLLC
Entity Type:Organization
Organization Name:BDC MEDICAL, PLLC
Other - Org Name:OKLAHOMA PAIN TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:DALBERT
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-751-0011
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0514
Mailing Address - Country:US
Mailing Address - Phone:405-751-0011
Mailing Address - Fax:405-751-7246
Practice Address - Street 1:14000 N PORTLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4004
Practice Address - Country:US
Practice Address - Phone:405-751-0011
Practice Address - Fax:405-751-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4887207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty