| Doctor Name: | DR. ERIC BLACKISTONE MIMS |
| NPI Number: | 1669419263 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | J0890 |
| Business Practice Address: | 1622 8th Avenue Suite 110 Fort Worth, TX - 761044155 |
| Business Phone Number: | 8179215447 |
| Business Fax Number: | 8179213708 |
| Mailing Address: | P.o. Box 961205, FORT WORTH |
| State: | TX |
| Postal Code: | 761611205 |
| Phone Number: | 8177408400 |
| Fax Number: | 8179213708 |
| NPI Enumeration Date: | 06/01/2006 |
| NPI Last Update Date: | 09/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207P00000X |
| License Number: | J0890 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |