Provider Demographics
NPI:1194796888
Name:BLATT, BRIAN T (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:BLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD SHEPARD PL STE 160
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5297
Mailing Address - Country:US
Mailing Address - Phone:972-612-4730
Mailing Address - Fax:972-398-9229
Practice Address - Street 1:4701 OLD SHEPARD PL STE 160
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5297
Practice Address - Country:US
Practice Address - Phone:972-612-4730
Practice Address - Fax:972-398-9229
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6533207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185619701Medicaid
TX185619702Medicaid
TX185619703Medicaid
TX185619703Medicaid
TX185619701Medicaid
TX8J6768Medicare PIN
TX8J6759Medicare PIN
TX8J6769Medicare PIN