MEDICARE: DR. BLAKE B O'LAVIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E3392	TX
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	E3392	TX
3	2084N0600X	Clinical Neurophysiology Physician	E3392	TX
4	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	E3392	TX
5	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	E3392	TX
6	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	E3392	TX
7	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	E3392	TX
8	2084N0400X	Neurology Physician	E3392	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	130010206	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	812585	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1093709578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE B O'LAVIN M.D.

Provider Business Mailing Address
First Line	:	409 COLONY DR
Second Line	:	SUITE 402
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-2674
Country	:	US
Telephone Number	:	361-883-1731
Fax Number	:	361-883-1440

Provider Business Practice Location Address
First Line	:	409 COLONY DR
Second Line	:	SUITE 402
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-2674
Country	:	US
Telephone Number	:	361-883-1731
Fax Number	:	361-883-1440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/13/2016

Similar Medicare Providers

1184556474 — CORPUS CHRISTI PREGNANCY CENTER, INC
Practice Location Address:

6133 ENNIS JOSLIN RD
CORPUS CHRISTI, TX
78412-2882

Practice Phone: 361-991-2008
Practice Fax:

1477485779 — KELLEY CHRISTINE JOHNSON
Practice Location Address:

6133 ENNIS JOSLIN RD
CORPUS CHRISTI, TX
78412-2882

Practice Phone: 361-728-9933
Practice Fax:

1497436034 — KEISHANA ROBINSON FNP
Practice Location Address:

7101 WILLIAMS DR
CORPUS CHRISTI, TX
78412-4947

Practice Phone: 361-854-1910
Practice Fax:

1801899349 — MRS. DANIELLA DEONA GRANTHAM WHNP
Practice Location Address:

7121 S PADRE ISLAND DR , STE 200
CORPUS CHRISTI, TX
78412-4940

Practice Phone: 361-993-6000
Practice Fax: 361-993-3676

1437153400 — EDWARD STANTON SHOEMAKER MD
Practice Location Address:

7121 S SPID DR , STE 200
CORPUS CHRISTI, TX
78412-4940

Practice Phone: 361-993-6000
Practice Fax: 361-993-3676

1346244316 — ROXANNA V DOUCET MD
Practice Location Address:

7121 S SPID DR , STE 200
CORPUS CHRISTI, TX
78412-4940

Practice Phone: 361-993-6000
Practice Fax: 361-993-3676

Directions to “ DR. BLAKE B O'LAVIN M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.