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General NPI Number Information
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NPI Number | 1861883753
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Entity Type | Organization
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Legal Business Name | ALFREDA D. BLACKSHEAR, M.D.
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 1215 LEE AVE
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City | TALLAHASSEE
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State | FL
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Zip | 32303-5850
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Country | US
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Telephone | 850-878-0229
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Fax | 850-942-5837
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Provider Business Mailing Address
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Address Line | 1215 LEE AVE
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City | TALLAHASSEE
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State | FL
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Zip | 32303-5850
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Country | US
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Telephone | 850-878-0229
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Fax | 850-942-5837
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFREDA D BLACKSHEAR
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Credential | M.D.
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Telephone | 850-878-0229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME40463
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License Number State | FL
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