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NPI Code Detail

MEDICARE: CRAIG BLACKWELL MD

MEDICARE: CRAIG BLACKWELL 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
1207W00000XOphthalmology PhysicianG52516CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326041195
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG BLACKWELL MD
Provider Business Mailing Address
First Line : 1667 DOMINICAN WAY
Second Line : STE 130
City : SANTA CRUZ
State : CA
Zip : 95065-1529
Country : US
Telephone Number : 831-462-9225
Fax Number : 831-462-6285
Provider Business Practice Location Address
First Line : 1667 DOMINICAN WAY
Second Line : STE 130
City : SANTA CRUZ
State : CA
Zip : 95065-1529
Country : US
Telephone Number : 831-462-9225
Fax Number : 831-462-6285
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 08/26/2008

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