Individual
DAVID BLALOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17576
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477591865
NPI
SC
01
—
17576
STATE LICENSE
SC
05
—
GP1830
—
SC
05
—
T15833
—
SC
Enumeration date
06/04/2006
Last updated
10/17/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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