Provider Demographics
NPI:1134399090
Name:BLYTHE, JOSEPH R (DO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:BLYTHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 269083
Mailing Address - Street 2:DEPT 1127
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9083
Mailing Address - Country:US
Mailing Address - Phone:405-418-4500
Mailing Address - Fax:405-418-4501
Practice Address - Street 1:13100 N WESTERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1431
Practice Address - Country:US
Practice Address - Phone:405-418-4500
Practice Address - Fax:405-418-4501
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 2653207X00000X
WI64999207X00000X
TNDO2653207XS0117X
OK8353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008670Medicaid
TNQ008670Medicaid