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General NPI Number Information
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NPI Number | 1235121864
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Entity Type | Individual
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Provider Name | WILLIAM FREDERICK BLANK III DPM
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 18960 N MEMORIAL DR
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City | HUMBLE
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State | TX
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Zip | 77338-4216
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Country | US
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Telephone | 281-540-6322
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Fax | 713-426-2034
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Provider Business Mailing Address
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Address Line | 21175 STATE HIGHWAY 249 # 192
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City | HOUSTON
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State | TX
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Zip | 77070-1655
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Country | US
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Telephone | 713-254-2883
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Fax | 713-426-2034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1416
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License Number State | TX
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