Provider Demographics
NPI:1518494616
Name:BLANKSON, BAABA KWEIBA (MD)
Entity Type:Individual
Prefix:
First Name:BAABA
Middle Name:KWEIBA
Last Name:BLANKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7495 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8002
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-247-7092
Practice Address - Street 1:10680 DEL MAR PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-4011
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-247-7092
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0064187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program