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General NPI Number Information
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NPI Number | 1568493179
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Entity Type | Individual
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Provider Name | JUDITH LOUISE BLACKWELL MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 9001 S 101ST EAST AVE SUITE 350
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City | TULSA
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State | OK
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Zip | 74133-5708
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Country | US
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Telephone | 918-293-6200
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Fax | 918-292-6245
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Provider Business Mailing Address
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Address Line | 9001 S 101ST EAST AVE STE 350
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City | TULSA
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State | OK
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Zip | 74133-5708
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Country | US
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Telephone | 918-293-6200
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Fax | 918-293-6245
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 13021
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License Number State | OK
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