MEDICARE: DR. BRANDON L BLOCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	F1394	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84Y120	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053370940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON L BLOCH M.D.

Provider Business Mailing Address
First Line	:	7610 STEMMONS FWY
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75247-4231
Country	:	US
Telephone Number	:	214-689-5960
Fax Number	:	214-630-7293

Provider Business Practice Location Address
First Line	:	3105 W 15TH ST
Second Line	:	SUITE B
City	:	PLANO
State	:	TX
Zip	:	75075-7700
Country	:	US
Telephone Number	:	972-769-1600
Fax Number	:	972-612-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	05/17/2010

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