Provider Demographics
NPI:1992179394
Name:BLAZE IOM READING, PLLC
Entity Type:Organization
Organization Name:BLAZE IOM READING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-500-7128
Mailing Address - Street 1:3102 MAPLE AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1261
Mailing Address - Country:US
Mailing Address - Phone:281-346-3480
Mailing Address - Fax:
Practice Address - Street 1:1511 ONYX CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-7805
Practice Address - Country:US
Practice Address - Phone:713-500-7128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty