Individual
BLAKE SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2405 CLEAR CREEK RD, KILLEEN, TX 76549-5775
(254) 618-1888
(254) 519-5264
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2568
NE
363A00000X
Physician Assistant
Primary
PA18017
TX
Other
Enumeration date
02/25/2021
Last updated
08/21/2024
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