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NPI Code Detail

MEDICARE: WILLIAM O BLACKSTONE M.D.

MEDICARE: WILLIAM O BLACKSTONE 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
1207P00000XEmergency Medicine PhysicianE2984TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21487639258OTHERTXTRICARE SOUTH
38Z2091OTHERTXBCBSTX PROV NO
41487639258OTHERTXBCBSTX

General Provider Information

NPI Number : 1487639258
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM O BLACKSTONE M.D.
Provider Business Mailing Address
First Line : PO BOX 200993
Second Line :
City : HOUSTON
State : TX
Zip : 77216-0993
Country : US
Telephone Number : 281-784-1111
Fax Number : 281-784-1555
Provider Business Practice Location Address
First Line : 8850 LONG POINT RD
Second Line :
City : HOUSTON
State : TX
Zip : 77055-3006
Country : US
Telephone Number : 713-722-3775
Fax Number : 713-722-3731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 11/11/2010

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