Provider Demographics
NPI:1619945839
Name:BLAKELY, JOHN P (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7970 FREDERICKSBURG RD
Mailing Address - Street 2:PMB #101-175
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3615 CULEBRA ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-314-6473
Practice Address - Fax:210-314-8676
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003007037207L00000X, 207LP2900X
TXL2144207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51403Medicare UPIN