MEDICARE: ROBERT BLALOCK 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	208000000X	Pediatrics Physician	J1103	TX
2	2080N0001X	Neonatal-Perinatal Medicine Physician	J1103	TX
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	J1103	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

General Provider Information

NPI Number	:	1437483427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BLALOCK M.D.

Provider Business Mailing Address
First Line	:	9826 FAIRCREST DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1542
Country	:	US
Telephone Number	:	214-341-2213
Fax Number	:	214-341-2271

Provider Business Practice Location Address
First Line	:	9826 FAIRCREST DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1542
Country	:	US
Telephone Number	:	214-341-2213
Fax Number	:	214-341-2271

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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