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General NPI Number Information
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NPI Number | 1104819028
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Entity Type | Individual
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Provider Name | JAY R BLACKMUR AA
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 29000 CENTER RIDGE RD
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City | WESTLAKE
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State | OH
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Zip | 44145-5293
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Country | US
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Telephone | 440-827-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 19250 BAGLEY RD #101
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City | CLEVELAND
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State | OH
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Zip | 44130-3314
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Country | US
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Telephone | 440-891-8800
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Fax | 440-891-1734
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 67-000061
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License Number State | OH
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