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General NPI Number Information
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NPI Number | 1811382062
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Entity Type | Individual
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Provider Name | BLAKE D HATFIELD M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2015
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3500 MAPLE AVE. STE 108 METHODIST MEDICAL GROUP SW
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 214-526-3566
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Fax | 214-947-8580
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Provider Business Mailing Address
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Address Line | 3629 FAIRMOUNT ST
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City | DALLAS
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State | TX
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Zip | 75219-4710
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Country | US
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Telephone | 214-526-3566
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Fax | 214-522-8619
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R7018
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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