Provider Demographics
NPI:1811954589
Name:BLOMGREN, JAMES K (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:BLOMGREN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:950 N PORTER
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6410
Mailing Address - Country:US
Mailing Address - Phone:405-329-0121
Mailing Address - Fax:405-292-6099
Practice Address - Street 1:950 N PORTER
Practice Address - Street 2:SUITE 300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6410
Practice Address - Country:US
Practice Address - Phone:405-329-0121
Practice Address - Fax:405-292-6099
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK12687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811954589Medicare PIN
C94695Medicare UPIN