Provider Demographics
NPI:1659427755
Name:ROBERT BLAYNEY MD
Entity Type:Organization
Organization Name:ROBERT BLAYNEY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAYNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-641-4309
Mailing Address - Street 1:7931 S BROADWAY
Mailing Address - Street 2:309
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2710
Mailing Address - Country:US
Mailing Address - Phone:720-641-4309
Mailing Address - Fax:303-347-6395
Practice Address - Street 1:7931 S BROADWAY
Practice Address - Street 2:309
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2710
Practice Address - Country:US
Practice Address - Phone:720-641-4309
Practice Address - Fax:303-347-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24896OtherSTATE LICENSE
CO24896OtherSTATE LICENSE