Provider Demographics
NPI:1912909508
Name:BLAKNEY, ERIC D (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:BLAKNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 323B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-756-6991
Mailing Address - Fax:901-756-6908
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 323B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-756-6991
Practice Address - Fax:901-756-6908
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN30789207RC0000X
MS218961207RC0000X
MS21896208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN260110399OtherAETNA
TN260110399OtherGREAT WEST
TN260110399OtherNALC
TN260110399OtherPRINCIPAL LIFE INSURANCE
TN260110399OtherCHAMPVA
TN260110399OtherJ.P. FARLEY
TN4108654OtherBLUECROSS BLUESHIELD
TN260110399OtherHUMANA
260110399OtherCIGNA
TN260110399OtherUNITED HEALTH CARE
TN3837940OtherMEDICARE ID-TYPE UNSPECIFIED
TN260110399OtherJ.P. FARLEY
TN3837940OtherMEDICARE ID-TYPE UNSPECIFIED