=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346537255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC SAMUEL BLACHER M.D., M.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2011
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6565 WEST LOOP S STE 101
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-377-6011
-----------------------------------------------------
Fax | 281-404-5307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6565 WEST LOOP S STE 101
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-377-6011
-----------------------------------------------------
Fax | 281-404-5307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | Q1096
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------