Provider Demographics
NPI:1841425477
Name:CHRISTENSEN, BLAKE DALBERT (DO)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:DALBERT
Last Name:CHRISTENSEN
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 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 1:14000 N PORTLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4004
Practice Address - Country:US
Practice Address - Phone:405-751-0011
Practice Address - Fax:405-751-7246
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135761207L00000X
OK4887207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200326560AMedicaid