Provider Demographics
NPI:1699383919
Name:BDC MEDICAL PLLC
Entity Type:Organization
Organization Name:BDC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
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 1:3101 W TECUMSEH RD STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1816
Practice Address - Country:US
Practice Address - Phone:405-751-0011
Practice Address - Fax:405-751-7246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BDC MEDICAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty