# DAVID BLALOCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1477591865
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 17576 | SC | Yes |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 10/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1477591865 | NPI | SC |
| 01 | — | 17576 | STATE LICENSE | SC |
| 05 | — | GP1830 | — | SC |
| 05 | — | T15833 | — | SC |