Individual
WILLIAM K BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 GRESHAM DR, MEDICAL TOWER, SUITE 702, NORFOLK, VA 23507-1901
(757) 533-5437
(757) 533-5602
Mailing address
400 GRESHAM DR, MEDICAL TOWER, SUITE 702, NORFOLK, VA 23507-1901
(757) 533-5437
(757) 533-5602
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
0101044962
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0063-3042-8
—
VA
01
—
099122
ANTHEM BCBS
VA
01
—
240001577
RR MEDICARE
VA
01
—
54-1546268
TAX ID
VA
Enumeration date
05/10/2006
Last updated
11/06/2012
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