Blaine Randall Blakestad, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

F1391 Issued in TX

Practice address

1201 W Frank Ave
Lufkin, TX 75904-3357

Phone

(936) 639-7696

Fax

(936) 639-7352

NPI assigned

May 27, 2006

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: blakestad@direct-address.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blaine Randall Blakestad MD PA

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lufkin, TX
  • NPI 1124346598
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1881641975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 BRENTWOOD DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759018853",
            "telephone_number": "936-639-7861",
            "fax_number": "936-639-7352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W FRANK AVE",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043357",
            "telephone_number": "936-639-7696",
            "fax_number": "936-639-7352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKESTAD",
        "first_name": "BLAINE",
        "middle_name": "RANDALL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "TX",
            "license": "F1391",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "F1391",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "TX",
            "license": "F1391",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214434701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8F6127",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danny Wayne Bizzell, LVN
• Shonna Nicole Bizzell
• Lynn Sobray Blackwell, OTR
• Blaine Randall Blakestad MD PA
• Cindy Blake
• Maria Magdalena Blalock, FNP
• Bonnie Lynn Bodenstedt, OTR/L
• Ivonne Boeta, MD
• Audrey Katherine Bogue, RD
• Donald B Bogue, OD

• General Practice Physician in Lufkin, TX
• Providers in Lufkin, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.