Provider Demographics
NPI:1811382062
Name:HATFIELD, BLAKE D (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:D
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3629 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4710
Mailing Address - Country:US
Mailing Address - Phone:214-526-3566
Mailing Address - Fax:214-522-8619
Practice Address - Street 1:3500 MAPLE AVE. STE 108
Practice Address - Street 2:METHODIST MEDICAL GROUP SW
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-526-3566
Practice Address - Fax:214-947-8580
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7018207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program