Individual
JOE BYNUM BOURLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1140 S DOUGLAS BLVD, MIDWEST CITY, OK 73130-5236
(405) 733-8000
Mailing address
11521 S WESTERN AVE STE B, OKLAHOMA CITY, OK 73170-5883
(405) 676-9125
(405) 400-8772
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
899
OK
363AM0700X
Medical Physician Assistant
899
OK
363AS0400X
Surgical Physician Assistant
899
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
899
MEDICAL LICENSE
OK
Enumeration date
11/08/2005
Last updated
10/04/2023
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