Healthcare Provider Details

I. General information

NPI: 1639431661
Provider Name (Legal Business Name): DARRYL THOMAS BLALOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 08/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 N DOWLEN ROAD
BEAUMONT TX
77706-7690
US

IV. Provider business mailing address

3460 N DOWLEN RD
BEAUMONT TX
77706-7690
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax: 409-839-3720
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-839-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number94-07982
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR1502
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: