John B Blalock Jr., M.D.
Individual provider Active NPI Surgery Physician · Culpeper, VA
NPI 1063685352 · NPPES record last updated May 27, 2020
Key facts
- NPI
- 1063685352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 0101263724 (VA)
- Practice address
- 541 Sunset LN Ste 103
Culpeper, VA 22701-3903 - Phone
- (540) 829-4440
- Fax
- (540) 825-4026
- NPI assigned
- Apr 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9169 | AL | MD | Surgery Physician |
| 0101263724 | VA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Virginia Physicians Group | Current |
Accepting new patients |
Locations
1215 Lee St
Fl 8
Charlottesvle, VA 22908
Phone (434) 924-2500
541 Sunset Ln
Ste 103
Culpeper, VA 22701
Phone (540) 321-3002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 9169 | AL | |
| Surgery Physician | 208600000X | 0101263724 | VA | Yes |
Addresses
Primary practice location
541 Sunset LN Ste 103
Culpeper, VA 22701-3903
Mailing address
2660 10TH Ave S
Suite 238
Birmingham, AL 35205-1605
Phone (205) 933-7301
Other practice location 1
2660 10th Ave S
Suite 238
Birmingham, AL 35205-1605
Phone (205) 933-7301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063685352 | Medicaid | VA | |
| 000087171 | Medicaid | AL |
Other providers in Culpeper, VA
- Crystal Gayle Berkeridge
- Jonathan M Bigwood
- Sharon M Bixby
- Black Butterfly Wellness, LLC
- Joyce Blair
- Kymberly Angelique Blankenship
- Blue Ridge Anes & Pain Services
- Blue Ridge Cardiovascular Associates
- Blue Ridge Gastroenterology
- Blue Ridge Gynecology & Wellness,Inc
All providers in Culpeper, VA · Surgery Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.