Individual
DR. RICHARD E BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 S 12TH ST, MURRAY, KY 42071-9303
(270) 759-9200
(270) 759-9966
Mailing address
1000 S 12TH ST, MURRAY, KY 42071-9303
(270) 759-9200
(270) 759-9966
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20341
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050313
ANTHEM BC BS
KY
01
—
110001757
RAILROAD MEDICARE
KY
01
—
610994960
TAX ID
KY
05
—
64203417
—
KY
Enumeration date
10/12/2005
Last updated
03/05/2018
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