Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | R8317 | TX |
NPI | 1013266691 |
---|---|
Provider Name | Dr. Ryan Eric Blalock |
First Address | Houston, TX 77065-3840 |
Second Address | Cypress, TX 77429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8KA00 | BCBS (01) | TX |