Provider Demographics
NPI:1124203344
Name:BARKER, BLAKE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ROBERT
Last Name:BARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD MAIL CODE 9126
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7208
Mailing Address - Country:US
Mailing Address - Phone:214-645-8630
Mailing Address - Fax:214-645-8631
Practice Address - Street 1:5323 HARRY HINES BLVD MAIL CODE 9126
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-8630
Practice Address - Fax:214-645-8631
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036125087Medicaid