Provider Demographics
NPI:1568481141
Name:BLUBAUGH, ROBERT D (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:BLUBAUGH
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 1:3622 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-3868
Mailing Address - Country:US
Mailing Address - Phone:601-482-6455
Mailing Address - Fax:
Practice Address - Street 1:1730 14TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-703-9600
Practice Address - Fax:601-703-9926
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS126822080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019324Medicaid