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General NPI Number Information
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NPI Number | 1871732594
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Entity Type | Organization
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Legal Business Name | BLG GROUP INC
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 2351 W NORTHWEST HWY STE 2235
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City | DALLAS
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State | TX
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Zip | 75220-4433
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Country | US
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Telephone | 214-674-7052
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Fax | 214-593-2913
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Provider Business Mailing Address
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Address Line | 2351 W NORTHWEST HWY STE 2235
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City | DALLAS
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State | TX
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Zip | 75220-4433
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Country | US
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Telephone | 214-674-7052
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Fax | 214-593-2913
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN LESLIE GWARTZ
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Credential | MD
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Telephone | 214-674-7052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | G2144
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License Number State | TX
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