Individual
SHANNON ELIZABETH BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5323 HARRY HINES BOULEVARD, DALLAS, TX 75390-7208
(214) 456-2333
(214) 456-6154
Mailing address
P.O. BOX 845347, DALLAS, TX 75284-5347
(214) 456-2333
(214) 456-6154
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
M1519
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204311905
—
TX
Enumeration date
08/05/2007
Last updated
08/15/2011
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