Healthcare Provider Details

I. General information

NPI: 1265428551
Provider Name (Legal Business Name): JAMES H. BLACKBURN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 S COLLEGE RD SUITE 102
LAFAYETTE LA
70503-3060
US

IV. Provider business mailing address

913 S COLLEGE RD SUITE 102
LAFAYETTE LA
70503-3060
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-2833
  • Fax: 337-234-4038
Mailing address:
  • Phone: 337-232-2833
  • Fax: 337-234-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number008728
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number008728
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number008728
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: