Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | F1394 | TX |
NPI | 1053370940 |
---|---|
Provider Name | Dr. Brandon L Bloch |
First Address | Dallas, TX 75247-4231 |
Second Address | Plano, TX 75075-7700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 17/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113978403 | (05) | TX |
84Y120 | BCBSTX (01) | TX |
C13536 | (02) | TX |