Healthcare Provider Details

I. General information

NPI: 1689250680
Provider Name (Legal Business Name): ANTHONY FINNAY BLACKBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # S321
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

PO BOX 233
GEYSERVILLE CA
95441-0233
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2773
  • Fax:
Mailing address:
  • Phone: 707-921-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: