MEDICARE: ANN E BLACKMAN 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	34727	IA
2	207Q00000X	Family Medicine Physician	2010007130	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00837677	OTHER	MO	RAILROAD MEDICARE
2	PO00168051	OTHER	IA	RR MEDICARE
5	135570022	OTHER	MO	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1588640510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN E BLACKMAN MD

Provider Business Mailing Address
First Line	:	608 OLD ROUTE 66
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-3730
Country	:	US
Telephone Number	:	573-336-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 OLD ROUTE 66
Second Line	:
City	:	SAINT ROBERT
State	:	MO
Zip	:	65584-3730
Country	:	US
Telephone Number	:	573-336-5100
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	01/13/2021

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Directions to “ ANN E BLACKMAN MD” Practice Location

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