Individual
DAVID M BLACKLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
100 HILLCREST MEDICAL BLVD, WACO, TX 76712-8897
(254) 202-2000
(254) 202-5849
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
F5119
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123356105
—
TX
05
—
125756005
—
TX
01
—
8AM187
BCBS
TX
Enumeration date
08/04/2006
Last updated
12/14/2021
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