Active NPI
Paul D Blaylock, MD
- Emergency Medicine Physician
- Aloha, OR
National Provider Identifier
1376589218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD08602
- Practice address
- 1881 NW 185TH Ave
Suite 101
Aloha, OR 97006-6822 - Phone
- (503) 216-9360
- Fax
- (503) 216-9363
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD08602 | OR | Primary |
Addresses
Primary practice location
1881 NW 185TH Ave
Suite 101
Aloha, OR 97006-6822
Mailing address
PO Box 13994
Portland, OR 97213-0994
Phone (503) 215-6494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00208130 | Other | OR | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD08602 | OR | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212364800000",
"number": "1376589218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13994",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972130994",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1881 NW 185TH AVE",
"address_2": "SUITE 101",
"city": "ALOHA",
"state": "OR",
"postal_code": "970066822",
"telephone_number": "503-216-9360",
"fax_number": "503-216-9363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAYLOCK",
"first_name": "PAUL",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-21",
"last_updated": "2008-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "OR",
"license": "MD08602",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00208130",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aloha, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.