Healthcare Provider Details

I. General information

NPI: 1497748552
Provider Name (Legal Business Name): ROBERT J BLOK JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

IV. Provider business mailing address

4101 TECHNOLOGY AVE
NEW ALBANY IN
47150-8548
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-5633
  • Fax: 812-981-3829
Mailing address:
  • Phone: 812-945-5633
  • Fax: 812-981-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number02002610A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02002610A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: