Provider Demographics
NPI:1760605455
Name:BLEASE, ROBERT ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERNEST
Last Name:BLEASE
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-6111
Mailing Address - Fax:208-625-6112
Practice Address - Street 1:2177 W IRONWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2639
Practice Address - Country:US
Practice Address - Phone:208-625-6111
Practice Address - Fax:208-625-6112
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-69984207X00000X
FLME108720207XX0801X, 207XX0801X
IDM-16171207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ038YOtherMEDICARE
FL010324800Medicaid
FLHQ038XOtherMEDICARE