Healthcare Provider Details

I. General information

NPI: 1437560448
Provider Name (Legal Business Name): BBMHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 4TH AVE STE 201
PURCELL OK
73080-1806
US

IV. Provider business mailing address

1515 HERITAGE DRIVE SUITE 110
MCKINNEY TX
75069-3379
US

V. Phone/Fax

Practice location:
  • Phone: 855-860-2109
  • Fax:
Mailing address:
  • Phone: 972-616-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23636
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16529
License Number StateOK

VIII. Authorized Official

Name: DAVID BRYAN DYE
Title or Position: OWNER
Credential: MD
Phone: 405-550-8325