MEDICARE: DAVID BLACKBURN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0203X	Therapeutic Radiology Physician	F8411	TX
2	2085R0001X	Radiation Oncology Physician	F8411	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245233360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BLACKBURN

Provider Business Mailing Address
First Line	:	6524 WAKEFOREST AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-3954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 HOSPITAL DR
Second Line	:
City	:	CORSICANA
State	:	TX
Zip	:	75110
Country	:	US
Telephone Number	:	713-515-7795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/26/2018

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Directions to “ DAVID BLACKBURN ” Practice Location

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