MEDICARE: BRIAN T BLATT DO

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	207RC0000X	Cardiovascular Disease Physician	M6533	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194796888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN T BLATT DO

Provider Business Mailing Address
First Line	:	4701 OLD SHEPARD PL STE 160
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5297
Country	:	US
Telephone Number	:	972-612-4730
Fax Number	:	972-398-9229

Provider Business Practice Location Address
First Line	:	4701 OLD SHEPARD PL STE 160
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5297
Country	:	US
Telephone Number	:	972-612-4730
Fax Number	:	972-398-9229

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/05/2020

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Directions to “ BRIAN T BLATT DO” Practice Location

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