Healthcare Provider Details

I. General information

NPI: 1972410694
Provider Name (Legal Business Name): PHILIP BLAHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S 2ND ST
ABBOTT TX
76621-3025
US

IV. Provider business mailing address

306 S 2ND ST
ABBOTT TX
76621-3025
US

V. Phone/Fax

Practice location:
  • Phone: 254-715-3620
  • Fax:
Mailing address:
  • Phone: 254-715-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1242174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: