Provider Demographics
NPI:1760477954
Name:BLACKSHEAR, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BLACKSHEAR
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 1:449 S OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-1101
Mailing Address - Country:US
Mailing Address - Phone:417-496-6654
Mailing Address - Fax:
Practice Address - Street 1:449 S OAKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-1101
Practice Address - Country:US
Practice Address - Phone:417-496-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999141055207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO194111OtherBCBS
OK2000100530AMedicaid
CAXPY202792Medicaid
MO20174319965616C002OtherTRICARE
MO204801609Medicaid
MO421313OtherHEALTHLINK
MOP00194816OtherRAILROAD
AR158593001Medicaid
MO204801625Medicaid
MO9917OtherCOX HEALTH
MO204801625Medicaid