Healthcare Provider Details

I. General information

NPI: 1457334450
Provider Name (Legal Business Name): MEGAN BLACKBURN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 W BELL RD STE 35
SUN CITY AZ
85351-1290
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 623-281-1130
  • Fax: 408-906-2179
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32492
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: