Provider Demographics
NPI:1639465925
Name:BLINN, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BLINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD # 2-A
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0591
Mailing Address - Country:US
Mailing Address - Phone:409-772-1221
Mailing Address - Fax:409-772-1224
Practice Address - Street 1:301 UNIVERSITY BLVD # 2-A
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555
Practice Address - Country:US
Practice Address - Phone:409-772-1221
Practice Address - Fax:409-772-1224
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200556207X00000X
TN57106207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery