Individual
DR. BLAYNE K STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
301 JENNY GEORGE LANE, BUILDING B, SUITE 5, SWEETWATER, TX 79556
(325) 219-6175
(325) 219-6179
Mailing address
301 JENNY GEORGE LN, BUILDING B, SUITE 5, SWEETWATER, TX 79556-7152
(325) 219-6175
(325) 219-6179
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
S6314
TX
208000000X
Pediatrics Physician
Primary
S6314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
426407901
—
TX
Enumeration date
06/08/2016
Last updated
06/13/2022
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