Provider Demographics
NPI:1285941922
Name:BARLOW, BLAKE EVAN (CPLPOFAAOP)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:EVAN
Last Name:BARLOW
Suffix:
Gender:M
Credentials:CPLPOFAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 BROADWAY EXT STE 204
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9031
Mailing Address - Country:US
Mailing Address - Phone:405-842-8505
Mailing Address - Fax:405-842-8805
Practice Address - Street 1:7510 BROADWAY EXT STE 204
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9031
Practice Address - Country:US
Practice Address - Phone:405-842-8505
Practice Address - Fax:405-842-8805
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1427376193Medicare PIN