| Doctor Name: | DR. JAMES DAVID BLACKBURN |
| NPI Number: | 1518337435 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C8902 |
| Business Practice Address: | 19499 State Highway 49 Jefferson, TX - 756575251 |
| Business Phone Number: | 9036658996 |
| Business Fax Number: | 9036658996 |
| Mailing Address: | 19499 State Hwy. 49, JEFFERSON |
| State: | TX |
| Postal Code: | 756575251 |
| Phone Number: | 9036658996 |
| Fax Number: | 9036658996 |
| NPI Enumeration Date: | 10/05/2015 |
| NPI Last Update Date: | 10/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C8902 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |