Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | TBD | TX |
NPI | 1033792411 |
---|---|
Provider Name | Nicholas Blasingame |
First Address | Argyle, TX 76226-2396 |
Second Address | Argyle, TX 76226-2396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |