# BLUE BAYOU INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043568538
- **Authorized official:** JAMES BRONSON (CEO)
- **Authorized official phone:** (405) 229-3410

## Contact information

- **Practice address:** 100 PARK AVE, OKLAHOMA CITY, OK 73102-8006
- **Practice address phone:** (405) 229-3410
- **Mailing address:** 100 PARK AVE, OKLAHOMA CITY, OK 73102-8006
- **Mailing address phone:** (405) 229-3410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | 12345 | OK | Yes |

## Other

- **Enumeration date:** 08/15/2012
- **Last updated:** 09/18/2012