Individual
DR. TRAVIS WAYNE BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 NE 13TH ST, OKLAHOMA CITY, OK 73104-5001
(405) 271-6110
Mailing address
1525 CLIFTON RD NE STE 112A, ATLANTA, GA 30322-4200
(404) 778-3333
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
73100
GA
207NS0135X
Procedural Dermatology Physician
A116875
CA
Other
Enumeration date
05/18/2007
Last updated
02/12/2021
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