Individual
DR. JEFFREY A BLALACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(316) 685-6091
Mailing address
6060 PRIMACY PKWY, SUITE 241, MEMPHIS, TN 38119-5745
(901) 725-5846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
24263
MS
207L00000X
Anesthesiology Physician
Primary
25520
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3084438
—
TN
Enumeration date
04/26/2006
Last updated
11/03/2016
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