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Organization

BLAKELY EMERGENCY GROUP PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SYLVAN WALLER MD (PRESIDENT)
(800) 893-9698
Entity
Organization

Contact information

Practice address
1400 MAIN ST, PECKVILLE, PA 18452-2009
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Enumeration date
09/09/2013
Last updated
09/09/2013
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