Individual
JAMES PHILLIP BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
529 N GALLOWAY AVE, SUITE 16, MESQUITE, TX 75149-3420
(972) 216-4411
(972) 216-0533
Mailing address
PO BOX 180065, DALLAS, TX 75218-0065
(972) 216-4411
(972) 216-0533
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
E9544
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116861904
—
TX
01
—
300126786
RAILROAD MEDICARE
TX
01
—
8G2805
BC BS TEXAS
TX
01
—
B011
CHAMPUS
TX
Enumeration date
10/03/2005
Last updated
07/24/2008
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