Blaine Randall Blakestad, MD is a
General Practice physician based in Lufkin, Texas. Blaine Randall Blakestad is licensed to practice in Texas (license number F1391) and his current practice location is 1201 W Frank Ave, Lufkin, Texas. He can be reached at his office (for appointments etc.) via phone at
(936) 639-7696.
NPI number for Blaine Randall Blakestad is 1881641975 and his current mailing address is 702 Brentwood Dr, Lufkin, Texas. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1881641975.
Physician's Profile
| Full Name | Blaine Randall Blakestad |
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| Gender | Male |
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| Speciality | General Practice |
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| Location | 1201 W Frank Ave, Lufkin, Texas |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1881641975
- Provider Enumeration Date: 05/27/2006
- Last Update Date: 09/29/2020
Medical Identifiers
Medical identifiers for Blaine Randall Blakestad such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1881641975 | NPI | - | NPPES |
| 214434701 | Medicaid | TX | |
| 8F6127 | Other | TX | BLUE CROSS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | F1391 (Texas) | Secondary |
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | F1391 (Texas) | Secondary |
| 208D00000X | General Practice | F1391 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Blaine Randall Blakestad is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Blaine Randall Blakestad, MD 702 Brentwood Dr, Lufkin, TX 75901-8853 Ph: (936) 639-7861 | Blaine Randall Blakestad, MD 1201 W Frank Ave, Lufkin, TX 75904-3357 Ph: (936) 639-7696 |
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