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NPI Code Detail

MEDICARE: KEVIN BLACKMON MD

MEDICARE: KEVIN BLACKMON MD
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
1207L00000XAnesthesiology Physician36968WA

General Provider Information

NPI Number : 1538121892
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN BLACKMON MD
Provider Business Mailing Address
First Line : 804 SCOTT NIXON MEMORIAL DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2464
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3624 ENSIGN RD NE
Second Line : STE B
City : OLYMPIA
State : WA
Zip : 98506-5074
Country : US
Telephone Number : 360-493-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 09/26/2012

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Directions to “ KEVIN BLACKMON MD” Practice Location

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