Healthcare Provider Details

I. General information

NPI: 1114992088
Provider Name (Legal Business Name): THOMAS C. BLEVINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 NORTH MO PAC EXPRESSWAY BUILDING 3, SUITE 200
AUSTIN TX
78731
US

IV. Provider business mailing address

6500 NORTH MO PAC EXPRESSWAY BUILDING 3, SUITE 200
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-458-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberF9214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: