Basic Information
| Provider Information | |||||||||
| NPI: | 1780205831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAGG | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 BREMEN DR | ||||||||
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| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760542229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156979299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2245 TEXAS DR STE 300 | ||||||||
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| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774791468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817686730 | ||||||||
| FaxNumber: | 2817686766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2020 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.