Provider Demographics
NPI:1639129505
Name:BLAIS, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BLAIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 6746
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-6746
Mailing Address - Country:US
Mailing Address - Phone:561-499-2277
Mailing Address - Fax:561-499-0775
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-2277
Practice Address - Fax:561-499-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 12838208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58229Medicare UPIN
FL71909ZMedicare PIN