Organization
KATHERINE R BLAKELEY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHERINE R BLAKELEY MD (PRESIDENT)
(972) 566-7777
Entity
Organization
Contact information
Practice address
7777 FOREST LN, SUITE A-310, DALLAS, TX 75230-2505
(972) 566-7777
(972) 566-7958
Mailing address
PO BOX 567629, DALLAS, TX 75356-7629
(972) 566-7777
(972) 566-7958
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
H7905
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X167
MEDICARE ID TYPE PIN
TX
Enumeration date
12/26/2006
Last updated
06/05/2008
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