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:
Health care specialties
| Specialty | Code | License # | 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 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568811636 | NPPES |
| Texas | MEDICAID | 426407901 |
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