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General NPI Number Information
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NPI Number | 1033106448
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Entity Type | Organization
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Legal Business Name | ROBERT V BLAKEBURN MD PC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 800 FRISCO AVE
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City | CLINTON
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State | OK
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Zip | 73601-3306
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Country | US
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Telephone | 580-323-2700
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Fax | 580-323-2718
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Provider Business Mailing Address
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Address Line | 800 FRISCO AVE
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City | CLINTON
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State | OK
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Zip | 73601-3306
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Country | US
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Telephone | 580-323-2700
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Fax | 580-323-2718
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ROBERT VAN BLAKEBURN
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Credential | MD
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Telephone | 580-323-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17199
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License Number State | OK
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