Provider Demographics
NPI:1104921212
Name:BLANTON, ROBERT H (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BLANTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:250 WEST
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-844-6620
Mailing Address - Fax:423-844-6627
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:250 WEST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6620
Practice Address - Fax:423-844-6627
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN24054208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
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TN3074381Medicaid
VA7305940Medicaid
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TN241060OtherINDIV ANTHEM/GROUP#093410