Individual
DAVID RUSSELL BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
H9805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123356109
—
TX
01
—
8EH325
BCBS
TX
01
—
P01445756
RAILROAD
TX
Enumeration date
02/27/2007
Last updated
06/08/2020
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