Blaylock, John Luther
Blaylock, John Luther is an sole proprietor health care provider with primary practice located at 2432 W Peoria Ave , Phoenix AZ 85029-4726. He recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as his primary health care specialty. Blaylock, John Luther can be contacted via phone (480) 431-5075.Contact Information
Primary practice address
2432 W Peoria Ave
Phoenix AZ 85029-4726
Phone: (480) 431-5075
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) | 261QM0801X |
Profile Details
| NPI number | 1467129478 |
|---|---|
| LBN Legal business name | Blaylock, John Luther |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 26th, 2021 |
| Last updated | Aug 30th, 2021 - about 4 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467129478 | NPPES |
| Other | NA | NA |
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