Walter Lee Blackburn D.O.

NPI 1457738494 - Student in an Organized Health Care Education/Training Program - 390200000X

NPI Details
NPI 1457738494
Gender Male
Enumeration Date 04/29/2015
Last Updated 04/29/2015
Entity Type Individual
Active Over 1 year ago
Practice Location
22 BRAMHALL ST
PORTLAND ME, 04102-3134, US
Phone (207) 662-0111
Fax
Business Location
5265 LAUREL DR
CONCORD CA, 94521-1543, US
Phone (208) 360-0954
Fax
Toxanomy
Taxonomy Code 390200000X
License State
License Number
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According to our database, Walter Lee Blackburn D.O. NPI is 1457738494, taxonomy code is 390200000X Walter Lee Blackburn D.O. physically located at 22 Bramhall St, Portland ME, 04102-3134. NPI Number Walter Lee Blackburn D.O. has the Individual type.

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1457738494 NPI number is provided on an as is basis without warranty of any kind. 1457738494 is maintained by the National Plan & Provider Enumeration System. The contents of Walter Lee Blackburn D.O. are for informational purposes only.