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NPI Code Detail

MEDICARE: ROBERT V BLAKEBURN MD PC

MEDICARE: ROBERT V BLAKEBURN MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician17199OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033106448
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT V BLAKEBURN MD PC
Provider Business Mailing Address
First Line : 800 FRISCO AVE
Second Line :
City : CLINTON
State : OK
Zip : 73601-3306
Country : US
Telephone Number : 580-323-2700
Fax Number : 580-323-2718
Provider Business Practice Location Address
First Line : 800 FRISCO AVE
Second Line :
City : CLINTON
State : OK
Zip : 73601-3306
Country : US
Telephone Number : 580-323-2700
Fax Number : 580-323-2718
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : ROBERT VAN BLAKEBURN
Credential : MD
Telephone Number : 580-323-2700
Provider Enumeration Date : 09/30/2005
Last Update Date : 04/01/2026

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