Doctor Name: | DR. EARNEST HOWARD-RUDOLPH BLACKSHEAR |
NPI Number: | 1386883932 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 0000 |
Business Practice Address: | 2400 Hospital Road, Bldg. 4a-233 Central Alabama Veterans Health Care System Tuskegee, AL - 360835001 |
Business Phone Number: | 3347270550 |
Business Fax Number: | 3347253262 |
Mailing Address: | Cavhcs, 2400 Hospital Road, Bldg. 4a-233 TUSKEGEE |
State: | AL |
Postal Code: | 36083 |
Phone Number: | 3347270550 |
Fax Number: | 3347253262 |
NPI Enumeration Date: | 02/05/2009 |
NPI Last Update Date: | 02/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 0000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |