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General NPI Number Information
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NPI Number | 1669470811
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Entity Type | Organization
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Legal Business Name | THOUSAND OAKS CLINIC WORK MED
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 2235 THOUSAND OAKS DR SUITE 115-117
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3966
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Country | US
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Telephone | 210-490-1000
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Fax | 210-490-3806
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Provider Business Mailing Address
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Address Line | 2235 THOUSAND OAKS DR SUITE 115-117
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3966
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Country | US
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Telephone | 210-490-1000
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Fax | 210-490-3806
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN DENNIS BLACKBURN
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Credential | MD
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Telephone | 210-490-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MDC7546
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License Number State | TX
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