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General NPI Number Information
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NPI Number | 1053533364
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Entity Type | Organization
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Legal Business Name | SHERYL L. BLAYLOCK M.D., P.A.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1105 SANTA FE SUITE 102
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City | WEATHERFORD
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State | TX
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Zip | 76086
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Country | US
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Telephone | 817-594-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SANTA FE SUITE 102
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City | WEATHERFORD
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State | TX
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Zip | 76086
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Country | US
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Telephone | 817-594-6620
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | SHERYL L BLAYLOCK
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Credential | M.D.
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Telephone | 817-594-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J8464
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License Number State | TX
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