MEDICARE: DR. CHRISTY R BLECKMAN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	TEMPORARY	MO

General Provider Information

NPI Number	:	1366568891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTY R BLECKMAN M.D.

Provider Business Mailing Address
First Line	:	851 E 5TH ST
Second Line	:	SUITE 328
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3135
Country	:	US
Telephone Number	:	636-239-1101
Fax Number	:	636-239-0250

Provider Business Practice Location Address
First Line	:	851 E 5TH ST
Second Line	:	SUITE 328
City	:	WASHINGTON
State	:	MO
Zip	:	63090-3130
Country	:	US
Telephone Number	:	636-239-1101
Fax Number	:	636-239-0250

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/22/2008

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