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General NPI Number Information
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NPI Number | 1073653820
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Entity Type | Organization
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Legal Business Name | JONATHAN BLAU MD PA
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 1814 ROSELAND BLVD SUITE 200
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City | TYLER
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State | TX
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Zip | 75701-4234
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Country | US
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Telephone | 903-593-6500
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Fax | 903-531-9535
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Provider Business Mailing Address
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Address Line | PO BOX 6547
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City | TYLER
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State | TX
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Zip | 75711-6547
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Country | US
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Telephone | 903-593-6500
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Fax | 903-531-9535
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. JONATHAN BLAU
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Credential | MD
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Telephone | 903-593-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | J4721
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License Number State | TX
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