BLAINE RANDALL BLAKESTAD MD - NPI 1881641975 - General Practice in Lufkin, TX

Q: What is Blaine Blakestad's NPI number?

The NPI number for Blaine Blakestad is 1881641975. It was assigned to this individual provider in the NPPES registry on May 27, 2006.

Q: What is Blaine Blakestad's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Blaine Blakestad was last updated on September 29, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Blaine Randall Blakestad Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLAINE RANDALL BLAKESTAD MD (NPI 1881641975) is an individual general practice provider in Lufkin, Texas, licensed in Texas (F1391) and active in the NPI registry since May 2006.

NPPES Registry Identity

NPI1881641975

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameBLAINE RANDALL BLAKESTADCredential: MD

Location Address1201 W FRANK AVELufkin, TX 75904-3357

Mailing Address702 Brentwood DrLufkin, TX 75901-8853 · (936) 639-7861 · Fax (936) 639-7352

Phone(936) 639-7696

Fax(936) 639-7352

Sole ProprietorYes

Enumeration DateMay 27, 2006

Last NPPES UpdateSeptember 29, 20202 updates tracked since enumeration

NPPES CertifiedSeptember 29, 2020

✔ NPI 1881641975 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in TX · F1391

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

Also ListedPreventive Medicine · Undersea and Hyperbaric MedicineTaxonomy 2083P0011X · License F1391 (TX)

Also ListedThoracic Surgery (Cardiothoracic Vascular Surgery)Taxonomy 208G00000X · License F1391 (TX)

1201 W FRANK AVE, Lufkin, TX 75904

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Other Identifiers 2

Medicaid214434701TX

Other8F6127TX · Blue Cross

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TEXAS EM-I MEDICAL SERVICES, PA

Emergency Medicine