Provider Demographics
NPI:1740574987
Name:BENDURE, WILLIAM BLAINE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAINE
Last Name:BENDURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 S WESTERN AVE STE 5000
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3441
Mailing Address - Country:US
Mailing Address - Phone:405-644-5160
Mailing Address - Fax:405-644-5162
Practice Address - Street 1:4221 S WESTERN AVE STE 5000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3441
Practice Address - Country:US
Practice Address - Phone:405-644-5160
Practice Address - Fax:405-644-5162
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK286522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology