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Individual
WILLIAM O BLACKSTONE
Active
Individual
WILLIAM O BLACKSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E2984
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135667709
—
TX
01
—
1487639258
TRICARE SOUTH
TX
01
—
8Z2091
BCBSTX PROV NO
TX
Enumeration date
12/14/2005
Last updated
11/11/2010
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