Healthcare Provider Details

I. General information

NPI: 1457318198
Provider Name (Legal Business Name): ROBERT EUGENE BLACKBURN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 EAST AVE HILTON HEALTH CARE, P.C.
HILTON NY
14468-1333
US

IV. Provider business mailing address

279 EAST AVE HILTON HEALTH CARE, P.C.
HILTON NY
14468-1333
US

V. Phone/Fax

Practice location:
  • Phone: 585-392-9100
  • Fax: 585-392-4020
Mailing address:
  • Phone: 585-392-9100
  • Fax: 585-392-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number169882
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: