Pablo Valle Blacio, MD, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

20476 Issued in AL

Legal business name

PABLO VALLE BLACIO, MD, LLC

Practice address

1101 Christine Ave
Anniston, AL 36207-4657

Phone

(256) 235-0717

Fax

(256) 235-0719

NPI assigned

May 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda Rooks

Title

Office Manager

Phone

(256) 235-0717

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1104036367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CHRISTINE AVE",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362074657",
            "telephone_number": "256-235-0717",
            "fax_number": "256-235-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 CHRISTINE AVE",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362074657",
            "telephone_number": "256-235-0717",
            "fax_number": "256-235-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PABLO VALLE BLACIO, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "ROOKS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-235-0717"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AL",
            "license": "20476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000979",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELDOFALAB",
            "identifier": "51000979",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Anniston, AL
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• Neurology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.