DR. Blayne K Street, D.O.

NPI #1568811636 in Sweetwater, Texas

Provider Information

NPI Number: 1568811636
Entity Type: Individual
Name: DR. Blayne K Street, D.O.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pediatrics
Credential: D.O.
Enumeration Date: Jun 8, 2016
Last Updated: Jun 13, 2022

Practice Location

Address: 301 JENNY GEORGE LANE
Address 2: BUILDING B, SUITE 5
City: Sweetwater
State: Texas
ZIP Code: 79556
Phone: (325) 219-6175

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Sports Medicine — Sports Medicine	207QS0010X
Pediatrics	208000000X	Primary

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