Brandon Robert Blalock
Individual provider Active NPI Other Technician · Overland Park, KS
NPI 1093560104 · NPPES record last updated Jan 15, 2025
Key facts
- NPI
- 1093560104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- Practice address
- 5799 Broadmoor St
Overland Park, KS 66202-2427 - Phone
- (660) 202-7899
- NPI assigned
- Apr 22, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | Yes |
Addresses
Primary practice location
5799 Broadmoor St
Overland Park, KS 66202-2427
Mailing address
5799 Broadmoor St
Overland Park, KS 66202-2427
Phone (660) 202-7899
Other providers in Overland Park, KS
- Jordin Blackwell
- Tiffany V Blackwell
- Kari Blair
- Maureen Elizabeth Blair
- Johnathon Blake
- Lauren Blando
- Lori Blankinship
- Derek Blau
- Megan Blaufuss
- John Sampson Bleazard
All providers in Overland Park, KS · Other Technician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.