| Doctor Name: | GARY ROBERT BLACKBURN |
| NPI Number: | 1467896258 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 501 S 9th St Suite 17 Noblesville, IN - 460602717 |
| Business Phone Number: | 3177740969 |
| Business Fax Number: | 3177745741 |
| Mailing Address: | 14098 Meadow Lake Dr, FISHERS |
| State: | IN |
| Postal Code: | 460385587 |
| Phone Number: | 3177740969 |
| Fax Number: | 3177745741 |
| NPI Enumeration Date: | 04/23/2013 |
| NPI Last Update Date: | 07/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |