Individual
BLAKE ORION THEABOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 ELIZABETH ST # 9B9.209, CORPUS CHRISTI, TX 78404-2235
(361) 861-1864
Mailing address
600 ELIZABETH ST # 9B9.209, CORPUS CHRISTI, TX 78404-2235
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
W5584
TX
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/16/2024
Last updated
05/08/2026
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