Basic Information
| Provider Information | |||||||||
| NPI: | 1013212331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAISDELL | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | SC | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 S UTICA AVE # 229 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175127201 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 635 W 11TH ST | ||||||||
| Address2: | OSU MEDICAL CENTER - DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183823535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 5139 | OK | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.