Individual
CLIFFORD BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
208 RACHELLE DR, OXFORD, MS 38655-6135
(662) 281-8700
Mailing address
208 RACHELLE DR, OXFORD, MS 38655-6135
(662) 281-8700
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R782755
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119446
—
MS
Enumeration date
06/05/2006
Last updated
11/30/2007
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