MEDICARE: VANCE G BLACKBURN M.D.

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	207Q00000X	Family Medicine Physician	00013452	AL

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
2	631156033	OTHER	AL	TAX ID #

General Provider Information

NPI Number	:	1720068463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANCE G BLACKBURN M.D.

Provider Business Mailing Address
First Line	:	2520 VALLEYDALE RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-2019
Country	:	US
Telephone Number	:	205-980-9944
Fax Number	:	205-980-9844

Provider Business Practice Location Address
First Line	:	2520 VALLEYDALE RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-2019
Country	:	US
Telephone Number	:	205-980-9944
Fax Number	:	205-980-9844

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	10/31/2025

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