Doctor Name: | DOUGLAS BLACKLIDGE |
NPI Number: | 1003901133 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 070007898 |
Business Practice Address: | 2330 S Dixon Rd Kokomo, IN - 469026400 |
Business Phone Number: | 7654555400 |
Business Fax Number: | 7658653912 |
Mailing Address: | 2330 S Dixon Rd, KOKOMO |
State: | IN |
Postal Code: | 469026400 |
Phone Number: | 7654555400 |
Fax Number: | 7658653912 |
NPI Enumeration Date: | 10/04/2006 |
NPI Last Update Date: | 10/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 070007898 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |