Organization
BLUE BAYOU INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES BRONSON (CEO)
(405) 229-3410
Entity
Organization
Contact information
Practice address
100 PARK AVE, OKLAHOMA CITY, OK 73102-8006
(405) 229-3410
Mailing address
100 PARK AVE, OKLAHOMA CITY, OK 73102-8006
(405) 229-3410
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
12345
OK
Other
Enumeration date
08/15/2012
Last updated
09/18/2012
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