1992959001 NPI number — DAVID JOHNSEN PHD AND ASSOCIATES PLLC

Table of content: DR. RICHARD SAMUEL BLUM D.C. (NPI 1104968130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992959001 NPI number — DAVID JOHNSEN PHD AND ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID JOHNSEN PHD AND ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992959001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 NW EXPRESSWAY
Provider Second Line Business Mailing Address:
STE 410W
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-7272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-755-8576
Provider Business Mailing Address Fax Number:
405-755-6026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 NW EXPRESSWAY
Provider Second Line Business Practice Location Address:
STE 410W
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73112-7272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-755-8576
Provider Business Practice Location Address Fax Number:
405-755-6026
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-755-8576

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  538 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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