Provider Demographics
NPI:1780914416
Name:FRENCH, BLAINE SPENCER (PA)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:SPENCER
Last Name:FRENCH
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 SOUTH 31ST STREET
Mailing Address - Street 2:CREDENTIALING SERVICES DEPT. OF MEDICAL STAFF SERVICES
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-0002
Mailing Address - Country:US
Mailing Address - Phone:254-724-0982
Mailing Address - Fax:254-724-0548
Practice Address - Street 1:2401 SOUTH 31ST STREET
Practice Address - Street 2:CREDENTIALING SERVICES DEPT. OF MEDICAL STAFF SERVICES
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76503-0002
Practice Address - Country:US
Practice Address - Phone:254-724-0982
Practice Address - Fax:254-724-0548
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06665363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical