Provider Demographics
NPI:1871543876
Name:BLAKEMAN, SCOT T (DO)
Entity type:Individual
Prefix:
First Name:SCOT
Middle Name:T
Last Name:BLAKEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088
Mailing Address - Country:US
Mailing Address - Phone:806-995-4122
Mailing Address - Fax:806-995-4663
Practice Address - Street 1:105 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088
Practice Address - Country:US
Practice Address - Phone:806-995-4122
Practice Address - Fax:806-995-4663
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131915402Medicaid
610819Medicare ID - Type Unspecified