BLAINE RANDALL BLAKESTAD (NPI# 1881641975) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881641975 |
| Entity Type | Individual |
| Full Name | BLAINE RANDALL BLAKESTAD |
| Credential | MD |
| Practice Address |
1201 W Frank Ave Lufkin TX 75904-3357 |
| Mailing Address |
702 Brentwood Dr Lufkin TX 75901-8853 |
| Practice Telephone | 9366397696 |
| Practice Fax Number | 9366397352 |
| Mailing Telephone | 9366397861 |
| Mailing Fax Number | 9366397352 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-09-29 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083P0011X |
Preventive Medicine Specialization: Undersea and Hyperbaric Medicine |
F1391 | TX | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | F1391 | TX | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | F1391 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 214434701 | 05 | |
| TX | BLUE CROSS | 8F6127 | 01 |
| Street Address |
1201 W FRANK AVE |
| City | LUFKIN |
| State | TX |
| Zip Code | 75904-3357 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629059548 | Joe Parker Tait | Registered Nurse | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2005-11-08 |
| 1851955033 | Shaquitta Lashae Hood | Licensed Vocational Nurse | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2019-04-23 |
| 1730653841 | Alejos Salais Jr. | Nurse Anesthetist, Certified Registered | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2019-01-11 |
| 1881173060 | Hospitalist Medicine Physicians of Texas - Lufkin, Pllc | Internal Medicine | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2018-08-09 |
| 1528578051 | Destiny Michelle New | Nurse Practitioner | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2017-10-11 |
| 1144748286 | Pineywoods Pain Associates, Pllc | Nurse Anesthetist, Certified Registered | 1201 W Frank Ave, Anesthesia Department, Lufkin, TX 75904-3357 | 2017-09-08 |
| 1336675032 | Patrick Imonitie Igharosa | Internal Medicine | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2017-05-02 |
| 1972053684 | Patricia Gay Lawson | Nurse Practitioner | 1201 W Frank Ave, Lufkin, TX 75904 | 2016-10-05 |
| 1811445091 | Morgan Grebe | Physician Assistant | 1201 W Frank Ave, Lufkin, TX 75904-3357 | 2016-09-15 |
| 1083162473 | Memorial Health System of East Texas | Clinic/Center | 1201 W Frank Ave, Lufkin, TX 75904 | 2016-09-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437759750 | David Kent Emmerling | Pharmacist | Walmart Pharmacy 10-0140, 2500 Daniel Mccall Drive, Lufkin, TX 75904 | 2020-10-27 |
| 1831732718 | Isaac Kwame Agyare | Pharmacist | 1522 West Frank Ave. Room 127, Lufkin, TX 75904 | 2019-10-23 |
| 1598314999 | Eva Faye Mcduffie | Technician | 1006 Sherwood Rd., Lufkin, TX 75904 | 2019-09-09 |
| 1477036119 | Tyra Williams | Occupational Therapy Assistant | 902 Hill Street, Lufkin, TX 75904 | 2018-09-10 |
| 1720560188 | Veronica Monique Kennedy | Pharmacist | 1522 West Frank, Lufkin, TX 75904 | 2018-09-02 |
| 1356821532 | Mark Anthony Plowman | Licensed Vocational Nurse | 379 Copperfield Loop, Lufkin, TX 75904 | 2018-08-17 |
| 1396222311 | Kevin Pulikottil Cherian | Occupational Therapist | 402 S John Redditt Dr., Lufkin, TX 75904 | 2018-07-23 |
| 1922593029 | Sarah Marie Stuart | Dentist | 103 N Brentwood Dr, Unit 400, Lufkin, TX 75904 | 2018-06-30 |
| 1083104004 | Pam Specialty Hospital of Lufkin, LLC | Long Term Care Hospital | 1201 W Frank Ave Ste D5, Lufkin, TX 75904 | 2018-05-15 |
| 1124523840 | Jane C Davidson | Nurse Practitioner | 1 Medical Center Blvd Ste C, Lufkin, TX 75904 | 2018-03-26 |
| Find all providers in zip 75904 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639465065 | Natalia Luraguiz | General Practice | 1605 W. Frank Avenue, Lufkin, TX 75904 | 2011-06-23 |
| 1477645547 | James E Saxton | General Practice | 300 N John Redditt, 7, Lufkin, TX 75904 | 2006-09-28 |
| 1932708351 | Rayburn Family Medicine | General Practice | 3804 S Medford Dr, Lufkin, TX 75901-5780 | 2020-10-19 |
| 1841514445 | C Doyle Haynes Md Pa | General Practice | 1105 W Frank Ave, Ste 290, Lufkin, TX 75904-3303 | 2010-03-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.