| NPI | 1710928155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAINE RANDALL BLAKESTAD Owner 936-634-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX OF1391) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-08-22 |