Individual provider · NPI-1

Dr. Travis Wayne Blalock, M.D.

Dermatology, MOHS-Micrographic Surgery · Oklahoma City, OK

NPI number1710195003
StatusActive
Last updated in NPPESFeb 12, 2021

Details

NPI
1710195003
Entity type
Individual (NPI-1)
Name
Dr. Travis Wayne Blalock
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
May 18, 2007
Certification date
Feb 12, 2021
Last updated
Feb 12, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207ND0101X Dermatology, MOHS-Micrographic Surgery73100GAYes
207NS0135X Dermatology, Procedural DermatologyA116875CA

Practice location

619 Ne 13th St
Oklahoma City, OK 73104-5001

Phone 405-271-6110

Mailing address

1525 Clifton Rd Ne Ste 112a
Atlanta, GA 30322-4200

Phone 404-778-3333

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