MEDICARE: M D PROSTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1427696145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M D PROSTHETICS

Provider Business Mailing Address
First Line	:	2000 CRAWFORD ST STE 1122
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-9065
Country	:	US
Telephone Number	:	832-217-7348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CRAWFORD ST STE 1122
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-9065
Country	:	US
Telephone Number	:	832-217-7348
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DARRELL BLAZE
Credential	:	LP
Telephone Number	:	832-217-7348

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2019

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Directions to “M D PROSTHETICS ” Practice Location

Language	Start Address	Practice Location

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