Healthcare Provider Details

I. General information

NPI: 1023043577
Provider Name (Legal Business Name): ROBERT BLANKENSHIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE
TULSA OK
74104-6520
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-3366
  • Fax: 918-403-6343
Mailing address:
  • Phone: 918-712-3366
  • Fax: 918-403-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number12857
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: