Provider Demographics
NPI:1831833375
Name:BLACKSTONE, CODY (DO)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:BLACKSTONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1739 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1639
Mailing Address - Country:US
Mailing Address - Phone:210-491-8179
Mailing Address - Fax:210-590-2664
Practice Address - Street 1:1739 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1639
Practice Address - Country:US
Practice Address - Phone:210-491-8179
Practice Address - Fax:210-590-2664
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXW0524207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine