MEDICARE: DR. MEREDITH WINSLOW BLALOCK ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	NT60199930	WA

General Provider Information

NPI Number	:	1649575333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH WINSLOW BLALOCK ND

Provider Business Mailing Address
First Line	:	423 W HILL ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-8637
Country	:	US
Telephone Number	:	405-818-0139
Fax Number	:

Provider Business Practice Location Address
First Line	:	5009 N PENNSYLVANIA AVE
Second Line	:	SUITE 116
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8887
Country	:	US
Telephone Number	:	405-443-0348
Fax Number	:	405-843-1494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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