Individual
ROBERT VAN BLAKEBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2085 S PACHECO ST, SANTA FE, NM 87505-6103
(505) 395-3000
Mailing address
800 FRISCO AVE, CLINTON, OK 73601-3306
(580) 323-2700
(580) 323-2276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
17199
OK
207Q00000X
Family Medicine Physician
Primary
MD2024-0859
NM
208100000X
Physical Medicine & Rehabilitation Physician
17199
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110960A
—
OK
Enumeration date
09/30/2005
Last updated
02/02/2026
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