Individual
ROBERT D BLANKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1 SHIRCLIFF WAY, JACKSONVILLE, FL 32204-4748
(904) 308-7300
Mailing address
PO BOX 863026, ORLANDO, FL 32886-3026
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
15-00330
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100343040B
—
KS
01
—
970016674
RAILROAD MEDICARE
KS
Enumeration date
03/14/2006
Last updated
05/23/2013
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