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Individual
JACOB BLACKMON
Active
Individual
JACOB BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
199052
TX
Other
Enumeration date
10/07/2024
Last updated
06/26/2026
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