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General NPI Number Information
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NPI Number | 1699759381
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Entity Type | Organization
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Legal Business Name | JOHN B BLALOCK JR MD PC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 2660 10TH AVE S STE 238
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1605
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Country | US
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Telephone | 205-933-7301
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Fax | 205-933-7304
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Provider Business Mailing Address
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Address Line | 2660 10TH AVE S STE 238
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1605
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Country | US
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Telephone | 205-933-7301
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Fax | 205-933-7304
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Authorized Official
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Title or Position | PRESIDENT JOHN B BLALOCK JR MD PC
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Name | JOHN B BLALOCK JR.
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Credential | MD
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Telephone | 205-933-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9169
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License Number State | AL
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