DARRYL THOMAS BLALOCK (NPI# 1639431661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639431661 |
| Entity Type | Individual |
| Full Name | DARRYL THOMAS BLALOCK |
| Credential | MD |
| Practice Address |
3650 Laurel St Beaumont TX 77707-2216 |
| Mailing Address |
3650 Laurel Avenue Beaumont TX 77706 |
| Practice Telephone | 4098380346 |
| Mailing Telephone | 4098380346 |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2018-01-31 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | R1502 | TX | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 94-07982 | KS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 377412701 | 05 | |
| TX | MEDICAL LICENSE | R1502 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003083478 | Darryl E Blalock | Nurse Anesthetist, Certified Registered | 743 Spring St Ne, Gainesville, GA 30501-3715 | 2008-05-14 |
| Street Address |
3650 LAUREL ST |
| City | BEAUMONT |
| State | TX |
| Zip Code | 77707-2216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346224359 | Sezefredo Paulo Depaiva | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2005-12-02 |
| 1316561715 | Brittany Paige Ellis | Registered Nurse | 3650 Laurel St, Beaumont, TX 77707-2216 | 2020-06-01 |
| 1952865552 | Katie C Holmes | Registered Nurse | 3650 Laurel St, Beaumont, TX 77707-2216 | 2019-01-28 |
| 1497239891 | Kristen Bradley | Registered Nurse | 3650 Laurel St, Beaumont, TX 77707-2216 | 2018-09-20 |
| 1619454220 | Traci Ann Rizk | Registered Nurse | 3650 Laurel St, Beaumont, TX 77707-2216 | 2018-07-26 |
| 1578076972 | Jason Sikes | Nurse Practitioner | 3650 Laurel St, Beaumont, TX 77707-2216 | 2017-11-08 |
| 1447512843 | Jeffrey Craig Humphrey | Nurse Practitioner | 3650 Laurel St, Beaumont, TX 77707-2216 | 2012-06-12 |
| 1679880785 | Jessica Joanne Bobinger | Specialist/Technologist, Other | 3650 Laurel St, Beaumont, TX 77707-2216 | 2010-09-10 |
| 1972833085 | Audrey Helen Reyenga | Physician Assistant | 3650 Laurel St, Beaumont, TX 77707-2216 | 2010-01-12 |
| 1417286261 | Dee Ann Vines | Licensed Vocational Nurse | 3650 Laurel St, Beaumont, TX 77707-2216 | 2009-12-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437718004 | Kelsey Marie Burt | Speech-Language Pathologist | 87 I-10, Beaumont, TX 77707 | 2019-06-07 |
| 1245898808 | Primary Care Anywhere, Pllc | Nurse Practitioner | 4347 Phelan, Suite 101, Beaumont, TX 77707 | 2019-05-30 |
| 1598321663 | Kacy Keitha Priddy | Occupational Therapist | 1846 I-10 S, Suite 102, Beaumont, TX 77707 | 2019-05-14 |
| 1144791963 | Jeffery Ray Manzer | Counselor | 3350 Dowlen Rd Suite J, Beaumont, TX 77707 | 2018-12-06 |
| 1497247217 | Haley Hebert | Speech-Language Pathologist | 87 I 10 N, Suite 225, Beaumont, TX 77707 | 2018-06-06 |
| 1548712383 | Taylor Miguez | Speech-Language Pathologist | 87 I-10 Frontage Rd #225, Beaumont, TX 77707 | 2016-10-27 |
| 1720534043 | Jacie Woodson | Speech-Language Pathologist | 87 I-10 Frontage Rd. 225, Beaumont, TX 77707 | 2016-08-28 |
| 1285187047 | Paula Boudreaux | Speech-Language Pathologist | 87 I-10 Frontage Rd, Suite 225, Beaumont, TX 77707 | 2016-07-28 |
| 1790138568 | Meagan Alyse Hartwick | Speech-Language Pathologist | 87 I-10 Frontage Rd., 225, Beaumont, TX 77707 | 2016-07-18 |
| 1376992578 | Laurie Lynette Jansky | Family Medicine | 3650 Laurel Ave, Beaumont, TX 77707 | 2016-06-08 |
| Find all providers in zip 77707 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952480550 | Michael J Grecula | Orthopaedic Surgery | 3650 Laurel Street, Beaumont, TX 77707 | 2006-11-03 |
| 1346224359 | Sezefredo Paulo Depaiva | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2005-12-02 |
| 1063922730 | Lamar University | Orthopaedic Surgery | 211 Redbird Ln, Beaumont, TX 77705-9801 | 2017-10-06 |
| 1295964583 | Eric Chapman | Orthopaedic Surgery | 3650 Laurel Street, Beaumont, TX 77707 | 2009-07-07 |
| 1801070842 | Matthew C Kergosien | Orthopaedic Surgery | 3650 Laurel Street, Beaumont, TX 77707 | 2007-12-27 |
| 1982709432 | Mark Thomas Reis | Orthopaedic Surgery | 81 Highland Springs Ave, Suite 103, Beaumont, CA 92223-3170 | 2006-09-13 |
| 1891898144 | Oscar Jovan Currie IIi | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2006-09-05 |
| 1083698898 | Jerry Doyle Clark | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2005-12-05 |
| 1992789713 | Burnet Todd Clarke | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2005-12-05 |
| 1144204967 | Jack Gober Mcneill | Orthopaedic Surgery | 3650 Laurel St, Beaumont, TX 77707-2216 | 2005-12-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.