Provider Demographics
NPI:1023337045
Name:ROBERT L BLAYNEY MD
Entity type:Organization
Organization Name:ROBERT L 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:303-347-8376
Mailing Address - Street 1:1537 W DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4496
Mailing Address - Country:US
Mailing Address - Phone:303-347-8376
Mailing Address - Fax:303-979-7949
Practice Address - Street 1:1537 W DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4496
Practice Address - Country:US
Practice Address - Phone:303-347-8376
Practice Address - Fax:303-979-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
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
COD24537Medicare UPIN