Individual
BLAKE TANEFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
590 MEDICAL CENTER ROAD, FORT CAVAZOS, TX 76544-5060
(254) 553-0627
Mailing address
8901 WISONSIN AVENUE, BETHESDA, MD 20889-0001
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101270189
VA
Other
Enumeration date
04/06/2019
Last updated
07/15/2024
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