Healthcare Provider Details

I. General information

NPI: 1134365869
Provider Name (Legal Business Name): BARRETT RANDALL BLAUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 WONDER WORLD DR STE 209
SAN MARCOS TX
78666-7541
US

IV. Provider business mailing address

1305 WONER WORLD DRIVE, STE 209
SAN MARCOS TX
78666-7541
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-7575
  • Fax: 512-396-7555
Mailing address:
  • Phone: 512-396-7575
  • Fax: 512-396-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN2008
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: