Basic Information
| Provider Information | |||||||||
| NPI: | 1811382062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATFIELD | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3629 FAIRMOUNT ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752194710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145263566 | ||||||||
| FaxNumber: | 2145228619 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 MAPLE AVE. STE 108 | ||||||||
| Address2: | METHODIST MEDICAL GROUP SW | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145263566 | ||||||||
| FaxNumber: | 2149478580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2015 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R7018 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.