Organization
WISE COUNTY ANESTHESIA ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BLAYLOCK DO (OWNER ANESTHESIOLOGIST)
(940) 627-3033
Entity
Organization
Contact information
Practice address
609 MEDICAL CENTER DR, DECATUR, TX 76234-4652
(940) 627-5921
Mailing address
PO BOX 1046, DECATUR, TX 76234-4652
(940) 627-3033
(940) 627-3572
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DOH9805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3536HM
BLUE CROSS GROUP ID NUMBE
TX
01
—
DOH9805
LICENSE NUMBER
TX
Enumeration date
02/07/2007
Last updated
08/22/2020
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