Healthcare Provider Details

I. General information

NPI: 1982607743
Provider Name (Legal Business Name): BLAKE ALLEN BAIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 14TH ST
PERRY OK
73077-5000
US

IV. Provider business mailing address

505 N 14TH ST STE C
PERRY OK
73077-5000
US

V. Phone/Fax

Practice location:
  • Phone: 580-336-3529
  • Fax: 580-336-2409
Mailing address:
  • Phone: 580-336-3529
  • Fax: 580-336-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16124
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: