Provider Demographics
NPI:1093709578
Name:O'LAVIN, BLAKE B (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:B
Last Name:O'LAVIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 COLONY DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2674
Mailing Address - Country:US
Mailing Address - Phone:361-883-1731
Mailing Address - Fax:361-883-1440
Practice Address - Street 1:409 COLONY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2674
Practice Address - Country:US
Practice Address - Phone:361-883-1731
Practice Address - Fax:361-883-1440
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2016-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE3392174400000X, 2084B0040X, 2084N0600X, 2084D0003X, 2084N0008X, 2084P2900X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129235102Medicaid
TX130010206OtherRAILROAD MEDICARE
TX812585OtherBCBS
TXB25252Medicare UPIN
TX00T631Medicare PIN