MEDICARE: DR. TAMINA ELAINE BLAIS M.D.

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	2085R0202X	Diagnostic Radiology Physician	J6341	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G0103214	OTHER	TX	DPS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J6341	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1568415842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMINA ELAINE BLAIS M.D.

Provider Business Mailing Address
First Line	:	2201 N RIVER HILLS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-2127
Country	:	US
Telephone Number	:	512-698-2096
Fax Number	:	512-402-0869

Provider Business Practice Location Address
First Line	:	2201 N RIVER HILLS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-2127
Country	:	US
Telephone Number	:	512-698-2096
Fax Number	:	512-402-0869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/07/2023

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