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Individual

HAROLD JASON BLALOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
501 MARSHALL ST. SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 353-3654
Mailing address
501 MARSHALL ST. SUITE 301, JACKSON, MS 39202
(601) 353-9900
(601) 353-3654

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
17167
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0124443
MS
01
02701951231
AMERICAN MEDICAL ASSOC.
MS
01
13012
AMERICAN BOARD OF UROLOGY
MS
01
340019033
MEDICARE - RAILROAD
MS
Enumeration date
07/02/2006
Last updated
08/01/2019
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