Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 12857 | OK |
NPI | 1023043577 |
---|---|
Provider Name | Robert Blankenship |
First Address | Tulsa, OK 74104-6520 |
Second Address | Tulsa, OK 74104-6520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100184350A | (05) | OK |
C94694 | (02) | OK |
P00324056 | RR MEDICARE (01) | OK |