MEDICARE: DR. ROBERT E BLACKWOOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME13523	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	080124987	OTHER	FL	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	71574	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043205826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E BLACKWOOD MD

Provider Business Mailing Address
First Line	:	7005 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-2509
Country	:	US
Telephone Number	:	941-792-2122
Fax Number	:	941-798-2019

Provider Business Practice Location Address
First Line	:	7005 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-2509
Country	:	US
Telephone Number	:	941-792-2122
Fax Number	:	941-798-2019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	02/21/2013

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Directions to “ DR. ROBERT E BLACKWOOD MD” Practice Location

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