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General NPI Number Information
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NPI Number | 1700068434
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Entity Type | Organization
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Legal Business Name | JOHN PAUL BLAKELY PA
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 6819 PLUM CREEK DR
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City | AMARILLO
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State | TX
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Zip | 79124-1602
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Country | US
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Telephone | 806-351-1560
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Fax | 806-351-0343
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Provider Business Mailing Address
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Address Line | PO BOX 50360
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City | AMARILLO
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State | TX
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Zip | 79159-0360
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Country | US
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Telephone | 806-351-1560
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Fax | 806-351-0343
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN PAUL BLAKELY
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Credential | D. O.
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Telephone | 806-241-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02003031A
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License Number State | TX
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