MEDICARE: DR. RICHARD E BLACKBURN 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	2084N0400X	Neurology Physician	ME61205	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1558467431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E BLACKBURN M.D.

Provider Business Mailing Address
First Line	:	2868 MAHAN DR
Second Line	:	SUITE 5
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5468
Country	:	US
Telephone Number	:	850-942-7177
Fax Number	:	850-656-9443

Provider Business Practice Location Address
First Line	:	2868 MAHAN DR
Second Line	:	SUITE 5
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5468
Country	:	US
Telephone Number	:	850-942-7177
Fax Number	:	850-656-9443

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/16/2010

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