Provider Demographics
NPI:1588628978
Name:BLAYLOCK, SHARRON DENISE (MD)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:DENISE
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SE FRANK PHILLIPS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3643
Mailing Address - Country:US
Mailing Address - Phone:918-214-8888
Mailing Address - Fax:918-214-8887
Practice Address - Street 1:309 SE FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3643
Practice Address - Country:US
Practice Address - Phone:918-214-8888
Practice Address - Fax:918-214-8887
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG78489Medicare UPIN