Larry W Blackburn MD

NPI 1063446417 - Family Medicine - 207Q00000X

NPI Details
NPI 1063446417
Gender Male
Enumeration Date 07/10/2006
Last Updated 12/11/2013
Entity Type Individual
Active Over 10 years ago
Practice Location
3920 WEST WHEATLAND ROAD
SUITE 152
DALLAS TX, 75237-3404, US
Phone (214) 467-0432
Fax (214) 467-0635
Business Location
3920 WEST WHEATLAND ROAD
SUITE 152
DALLAS TX, 75237-3404, US
Phone (214) 467-0432
Fax (214) 467-0635
Toxanomy
Taxonomy Code 207Q00000X
License State Texas
License Number G8003
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According to our database, Larry W Blackburn MD NPI is 1063446417, taxonomy code is 207Q00000X and license number is G8003, license state is located at Texas. Larry W Blackburn MD physically located at 3920 West Wheatland Road, Dallas TX, 75237-3404. NPI Number Larry W Blackburn MD has the Individual type.

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1063446417 NPI number is provided on an as is basis without warranty of any kind. 1063446417 is maintained by the National Plan & Provider Enumeration System. The contents of Larry W Blackburn MD are for informational purposes only.