Provider Demographics
NPI:1215919634
Name:BLEVINS, NISKA AARON (DO)
Entity type:Individual
Prefix:DR
First Name:NISKA
Middle Name:AARON
Last Name:BLEVINS
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 1:929 CANTEBURY AVE
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3248
Mailing Address - Country:US
Mailing Address - Phone:806-319-1712
Mailing Address - Fax:
Practice Address - Street 1:929 CANTEBURY AVE
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382
Practice Address - Country:US
Practice Address - Phone:806-319-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010215072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology