Healthcare Provider Details

I. General information

NPI: 1821240318
Provider Name (Legal Business Name): DAVID BRIAN BARDELL MLT (ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4936
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-948-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberMLT #55764
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: