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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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