Blalock, Tully T.

Blalock, Tully T. is an individual health care provider with primary practice located at 220 Barton Blvd Unit C14, Rockledge FL 32955-2742. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Blalock, Tully T. can be contacted via phone (321) 639-5177.

Contact Information

Primary practice address
220 Barton Blvd Unit C14 Rockledge FL 32955-2742
Phone: (321) 639-5177
Fax: (321) 639-4927
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X ME26001 Florida

Profile Details

NPI number 1417004359
LBN Legal business name Blalock, Tully T.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2007
Last updated Sep 12th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417004359 NPPES
Florida MEDICAID 002048700

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