Provider Demographics
NPI:1053370940
Name:BLOCH, BRANDON L (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
Last Name:BLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7610 STEMMONS FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4231
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:214-630-7293
Practice Address - Street 1:3105 W 15TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7700
Practice Address - Country:US
Practice Address - Phone:972-769-1600
Practice Address - Fax:972-612-3473
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF1394207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84Y120OtherBCBSTX
TX113978403Medicaid
TX84Y120Medicare PIN
TX113978403Medicaid
TX100007704Medicare PIN