Healthcare Provider Details

I. General information

NPI: 1063378271
Provider Name (Legal Business Name): CITY DIFFERENT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 S PACHECO ST
SANTA FE NM
87505-6103
US

IV. Provider business mailing address

2085 S PACHECO ST
SANTA FE NM
87505-6103
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BLAKEBURN
Title or Position: OWNER
Credential: MD
Phone: 580-445-0773