Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 581875 | TX |
NPI | 1063829257 |
---|---|
Provider Name | Dr. Blake Arden Yarascavitch |
First Address | Dallas, TX 75235-7701 |
Second Address | Dallas, TX 75235-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2014 |
Last Update Date | 20/07/2014 |