Provider Demographics
NPI:1538148341
Name:BLAKLEY, OLGA PAVLOVNA (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:PAVLOVNA
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:PAVLOVNA
Other - Last Name:SHELEPUGINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2300
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146751207L00000X
TXL9627207L00000X
ARE4506207LP2900X, 207L00000X
CAA86519207L00000X
MS17235207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186548713Medicaid
IL214881OtherMEDICARE MULTISPECIALTY GROUP PTAN
TX8FW599OtherBCBS
TXP01745927OtherRR MEDICARE
TXP01745927OtherRR MEDICARE