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General NPI Number Information
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NPI Number | 1649221177
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Entity Type | Individual
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Provider Name | BERT ERIC BLACKWELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 4538 S HARVARD AVE
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City | TULSA
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State | OK
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Zip | 74135-2906
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Country | US
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Telephone | 918-712-3377
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Fax | 918-712-3373
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Provider Business Mailing Address
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Address Line | 1145 S UTICA AVE STE 110
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City | TULSA
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State | OK
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Zip | 74104-4013
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Country | US
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Telephone | 918-579-6863
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Fax | 918-579-6869
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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 | 3343
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 3343
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License Number State | OK
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