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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22403
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4476
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:888-902-1099
Practice Address - Street 1:6005 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5212
Practice Address - Country:US
Practice Address - Phone:901-761-2100
Practice Address - Fax:901-761-1442
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21896208M00000X
MS218961207RC0000X
TN30789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
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