Fred Blackledge M.D.

NPI 1003890179 - Plastic Surgery - 208200000X

NPI Details
NPI 1003890179
Gender Male
Enumeration Date 12/02/2005
Last Updated 07/08/2007
Entity Type Individual
Active Over 12 years ago
Practice Location
JACKSON MS, 39216-4617, US
Phone (601) 981-3033
Fax (601) 982-8132
Business Location
PO BOX 24023
JACKSON MS, 39225-4023, US
Phone (601) 366-1400
Fax (601) 366-8167
Taxonomy Code 208200000X
License State Mississippi
License Number 16006
Remove 1003890179 NPI Number

According to our database, Dr. Fred Blackledge M.D. NPI is 1003890179, taxonomy code is 208200000X and license number is 16006, license state is located at Mississippi. Fred Blackledge M.D. physically located at 764 Lakeland Dr, Jackson MS, 39216-4617. NPI Number Fred Blackledge M.D. has the Individual type.

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1003890179 NPI number is provided on an as is basis without warranty of any kind. 1003890179 is maintained by the National Plan & Provider Enumeration System. The contents of Fred Blackledge M.D. are for informational purposes only.