Provider Demographics
NPI:1982607743
Name:BAIRD, BLAKE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:ALLEN
Last Name:BAIRD
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 1:505 N 14TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5000
Mailing Address - Country:US
Mailing Address - Phone:580-336-3529
Mailing Address - Fax:580-336-2409
Practice Address - Street 1:505 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5000
Practice Address - Country:US
Practice Address - Phone:580-336-3529
Practice Address - Fax:580-336-2409
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731341903OtherTAX ID
OK100196260AMedicaid
OKE08006Medicare UPIN
OK400522183Medicare ID - Type UnspecifiedPRACITCE NUMBER