Individual
TEDDY BLODGETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7761 FM 14, TRLR 60, TYLER, TX 75706-7854
(903) 216-5427
(903) 526-4110
Mailing address
7761 FM 14, TRLR 60, TYLER, TX 75706-7854
(903) 216-5427
(903) 526-4110
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
26-3003000
TX
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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