Provider Demographics
NPI:1962440529
Name:BLAKEY, JOHN MALONEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MALONEY
Last Name:BLAKEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0980
Mailing Address - Country:US
Mailing Address - Phone:662-620-7101
Mailing Address - Fax:662-842-1457
Practice Address - Street 1:830 S GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4934
Practice Address - Country:US
Practice Address - Phone:662-620-7101
Practice Address - Fax:662-842-1457
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS057022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology