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Individual
GREGORY ANDREW BLACKMAN
Active
Individual
GREGORY ANDREW BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2000020732
NULL
363A00000X
Physician Assistant
1174263
NULL
363AS0400X
Surgical Physician Assistant
Primary
PA100402
MA
Other
Enumeration date
08/28/2016
Last updated
12/14/2025
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