Provider Demographics
NPI:1760048185
Name:WOMACK, BLANE CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANE
Middle Name:CHARLES
Last Name:WOMACK
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 1:1876 US HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-4600
Mailing Address - Country:US
Mailing Address - Phone:806-470-0506
Mailing Address - Fax:
Practice Address - Street 1:1876 US HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-4600
Practice Address - Country:US
Practice Address - Phone:806-470-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10066651207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine