Blakestad, Blaine Randall
Blakestad, Blaine Randall is an sole proprietor health care provider with primary practice located at 1201 W Frank Ave , Lufkin TX 75904-3357. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery), Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Blakestad, Blaine Randall can be contacted via phone (936) 639-7696.Contact Information
Primary practice address
1201 W Frank Ave
Lufkin TX 75904-3357
Phone: (936) 639-7696
Fax: (936) 639-7352
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine | 2083P0011X | F1391 | Texas |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | F1391 | Texas |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | F1391 | Texas |
Profile Details
| NPI number | 1881641975 |
|---|---|
| LBN Legal business name | Blakestad, Blaine Randall |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 27th, 2006 |
| Last updated | Sep 29th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881641975 | NPPES |
| Texas | MEDICAID | 214434701 | |
| Texas | Other | 8F6127 |
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