Provider Demographics
NPI:1184164923
Name:ROBBINS, BLAKE A (DO)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:A
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11612 BEE CAVES RD STE 175
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5409
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:512-323-5880
Practice Address - Street 1:11612 BEE CAVES RD STE 175
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-5409
Practice Address - Country:US
Practice Address - Phone:512-451-0139
Practice Address - Fax:512-323-5880
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP61162867207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1184164923Medicaid