Healthcare Provider Details

I. General information

NPI: 1649438730
Provider Name (Legal Business Name): JOHN RAY BLEVINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W ILLINOIS AVE
MIDLAND TX
79701-6407
US

IV. Provider business mailing address

502 W MONTGOMERY ST # 268
WILLIS TX
77378-8827
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-1111
  • Fax: 432-686-5353
Mailing address:
  • Phone: 432-352-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN4302
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN4302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: