Blaylock, Wilmer Kenneth

Blaylock, Wilmer Kenneth is an individual health care provider with primary practice located at 1250 E Marshall St Dermatology -, Richmond VA 23298-5051. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Blaylock, Wilmer Kenneth can be contacted via phone (804) 828-9361.

Contact Information

Primary practice address
1250 E Marshall St Dermatology - Richmond VA 23298-5051
Phone: (804) 828-9361
Fax: (804) 828-9596
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 0101013569 Virginia

Profile Details

NPI number 1417982778
LBN Legal business name Blaylock, Wilmer Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417982778 NPPES
Virginia MEDICAID 5911761

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