Healthcare Provider Details

I. General information

NPI: 1134399090
Provider Name (Legal Business Name): JOSEPH R BLYTHE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

IV. Provider business mailing address

PO BOX 269083 DEPT 1127
OKLAHOMA CITY OK
73126-9083
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-4500
  • Fax: 405-418-4501
Mailing address:
  • Phone: 405-418-4500
  • Fax: 405-418-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO 2653
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number64999
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberDO2653
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number8353
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: