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General NPI Number Information
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NPI Number | 1093334567
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Entity Type | Individual
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Provider Name | JOSHUA AARON BLACKWELL MD, MSPH
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Gender | Male
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 912 PINE ST
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City | MOUNT SHASTA
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State | CA
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Zip | 96067-2143
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Country | US
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Telephone | 205-603-8010
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Fax |
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Provider Business Mailing Address
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Address Line | 3719 E ELMWOOD DR
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City | WICHITA
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State | KS
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Zip | 67218-4824
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Country | US
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Telephone | 205-603-8010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14283-320
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-49978
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 52272
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-55925
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T7872
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A206348
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License Number State | CA
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