Provider Demographics
NPI:1427696145
Name:M D PROSTHETICS
Entity type:Organization
Organization Name:M D PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAZE
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:832-217-7348
Mailing Address - Street 1:2000 CRAWFORD ST STE 1122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9065
Mailing Address - Country:US
Mailing Address - Phone:832-217-7348
Mailing Address - Fax:
Practice Address - Street 1:2000 CRAWFORD ST STE 1122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9065
Practice Address - Country:US
Practice Address - Phone:832-217-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty