Individual
DR. BLAKE B O'LAVIN
Active
Individual
DR. BLAKE B O'LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
E3392
TX
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
E3392
TX
2084D0003X
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
E3392
TX
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
E3392
TX
2084N0400X
Neurology Physician
Primary
E3392
TX
2084N0600X
Clinical Neurophysiology Physician
E3392
TX
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
E3392
TX
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
E3392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129235102
—
TX
01
—
130010206
RAILROAD MEDICARE
TX
01
—
812585
BCBS
TX
Enumeration date
09/09/2005
Last updated
12/13/2016
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