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Organization
BLAINE RANDALL BLAKESTAD MD PA
Active
Organization
BLAINE RANDALL BLAKESTAD MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE RANDALL BLAKESTAD MD (PRESIDENT)
(936) 632-5894
Entity
Organization
Contact information
Practice address
1201 W FRANK AVE, LUFKIN, TX 75904-3357
(936) 634-8111
Mailing address
702 BRENTWOOD DR, LUFKIN, TX 75901-8853
(936) 632-5894
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
F1391
TX
Other
Enumeration date
05/11/2010
Last updated
09/09/2010
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