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General NPI Number Information
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NPI Number | 1134549884
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Entity Type | Individual
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Provider Name | AMY BLACKMON MD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1600 E CITRUS AVE
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City | REDLANDS
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State | CA
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Zip | 92374-4270
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Country | US
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Telephone | 909-794-3682
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A144585
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License Number State | CA
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