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General NPI Number Information
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NPI Number | 1609631886
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Entity Type | Individual
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Provider Name | ROBERT LEE BLACKMAN JR.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 645 HIGHWAY 80 E
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City | MONROE
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State | LA
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Zip | 71203-8527
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Country | US
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Telephone | 318-343-8744
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Fax |
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Provider Business Mailing Address
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Address Line | 21 KATHY LN
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City | MONROE
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State | LA
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Zip | 71203-2769
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Country | US
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Telephone | 318-791-2017
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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