NPI 1396072344

Big Blue Star LLC

Organisation Registered Dietitian Edmond, OK

Practice location

Address: 1800 Renaissance Blvd STE 200, Edmond, OK 73013-3023
Phone: (404) 359-2473

Authorised official

Name: Toby Daniel Broussard
Title: Co Owner
Phone: (405) 974-8412

Registered specialties (4)

Registered Dietitian Primary

Dietary & Nutritional Service Providers Taxonomy 133V00000X

Other Dietitian, Registered providers in Oklahoma →

Specialist

Other Service Providers Taxonomy 174400000X

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Surgery Physician

Allopathic & Osteopathic Physicians Taxonomy 208600000X

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Clinical Medical Laboratory

Laboratories Taxonomy 291U00000X

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Registry record

NPI: 1396072344
Entity type: Organization
NPI issued: 12 Nov 2009
Record last updated: 17 Dec 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.