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General NPI Number Information
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NPI Number | 1326103797
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Entity Type | Organization
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Legal Business Name | KATHERINE R BLAKELEY MD PA
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 7777 FOREST LN SUITE A-310
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-7777
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Fax | 972-566-7958
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Provider Business Mailing Address
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Address Line | PO BOX 567629
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City | DALLAS
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State | TX
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Zip | 75356-7629
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Country | US
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Telephone | 972-566-7777
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Fax | 972-566-7958
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHERINE R BLAKELEY
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Credential | MD
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Telephone | 972-566-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | H7905
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License Number State | TX
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