Street, Blayne K

Street, Blayne K is an individual health care provider with primary practice located at 301 Jenny George Lane Building B, Suite 5, Sweetwater TX 79556. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Street, Blayne K can be contacted via phone (325) 219-6175.

Contact Information

Primary practice address
301 Jenny George Lane Building B, Suite 5 Sweetwater TX 79556
Phone: (325) 219-6175
Fax: (325) 219-6179
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X S6314 Texas
Allopathic & Osteopathic Physicians / Pediatrics 208000000X S6314 Texas

Profile Details

NPI number 1568811636
LBN Legal business name Street, Blayne K
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2016
Last updated Jun 13th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568811636 NPPES
Texas MEDICAID 426407901

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