Provider Demographics
NPI:1518075621
Name:BLAKELY, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4848 SW 21ST ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-4415
Mailing Address - Country:US
Mailing Address - Phone:785-272-5566
Mailing Address - Fax:785-272-5967
Practice Address - Street 1:4848 SW 21ST ST
Practice Address - Street 2:STE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-4415
Practice Address - Country:US
Practice Address - Phone:785-272-5566
Practice Address - Fax:785-252-5967
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04208642084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100778OtherBLUE SHIELD OF KS
KS100778Medicare ID - Type UnspecifiedMEDICARE