Healthcare Provider Details

I. General information

NPI: 1962311365
Provider Name (Legal Business Name): DAVID BLANE HOUSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BLANE DAVID HOUSTON

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MINERAL WELLS AVE STE 17
PARIS TN
38242-4962
US

IV. Provider business mailing address

1055 MINERAL WELLS AVE STE 17
PARIS TN
38242-4962
US

V. Phone/Fax

Practice location:
  • Phone: 731-203-1670
  • Fax:
Mailing address:
  • Phone: 731-203-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1154
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: