Provider Demographics
NPI:1659064061
Name:BECKNER, BLAKE THOMAS
Entity Type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:THOMAS
Last Name:BECKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N WESTAIRE ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5661
Mailing Address - Country:US
Mailing Address - Phone:405-795-1410
Mailing Address - Fax:
Practice Address - Street 1:1501 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6611
Practice Address - Country:US
Practice Address - Phone:405-404-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist