Tully T. Blalock Jr., MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME26001 Issued in FL

Practice address

220 Barton Blvd
Unit C14
Rockledge, FL 32955-2742

Phone

(321) 639-5177

Fax

(321) 639-4927

NPI assigned

Jan 4, 2007

Last updated

Sep 12, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Winter Park Family Practice LLC

  dba Family Practice of Winter Park

  • Family Medicine Physician
  • Maitland, FL
  • NPI 1740268929
  NPD (past)
• Florida Care Level Management Direct, LLC

  • General Practice Physician
  • Calabasas, CA
  • NPI 1770569220
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1417004359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-952-9696",
            "fax_number": "321-952-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BARTON BLVD",
            "address_2": "UNIT C14",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552742",
            "telephone_number": "321-639-5177",
            "fax_number": "321-639-4927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "TULLY",
        "middle_name": "T.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME26001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002048700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Berthiaume Chiropractic PA
• Alexis Best, PA-C
• Michael C Bishop, B.S, D.C.
• Tiffany Joi Blackmon, PHARMD.
• Jesse Blain I
• Jayna-Lonyea Blanks
• Blessings Adult Family Care Home (Jean A. Vecchione)
• Bobby Abraham MD PA
• Daniel Louis Bologna, LCSW
• Courtney Bordac

• Internal Medicine Physician in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.