MEDICARE: WILLIAM BLAINE BENDURE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	28652	OK

General Provider Information

NPI Number	:	1740574987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BLAINE BENDURE MD

Provider Business Mailing Address
First Line	:	4221 S WESTERN AVE STE 5000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3441
Country	:	US
Telephone Number	:	405-644-5160
Fax Number	:	405-644-5162

Provider Business Practice Location Address
First Line	:	4221 S WESTERN AVE STE 5000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3441
Country	:	US
Telephone Number	:	405-644-5160
Fax Number	:	405-644-5162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2011
Last Update Date	:	08/01/2016

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