Healthcare Provider Details

I. General information

NPI: 1679903512
Provider Name (Legal Business Name): DAVID ALAN BLACKMAN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 COURT ST
ELKO NV
89801-3942
US

IV. Provider business mailing address

997 COURT ST
ELKO NV
89801-3942
US

V. Phone/Fax

Practice location:
  • Phone: 775-778-0507
  • Fax: 775-778-0987
Mailing address:
  • Phone: 775-778-0507
  • Fax: 775-778-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: