Provider Demographics
NPI:1528026838
Name:BLEM, ROBERT I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
Last Name:BLEM
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 1:1000 W PINHOOK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-264-1011
Mailing Address - Fax:337-264-1211
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-264-1011
Practice Address - Fax:337-264-1211
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14948R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162779Medicaid
LA4F103Medicare ID - Type Unspecified
LA1162779Medicaid