Individual
DR. FRED BLACKLEDGE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
764 LAKELAND DR, JACKSON, MS 39216-4617
(601) 981-3033
(601) 982-8132
Mailing address
PO BOX 24023, JACKSON, MS 39225-4023
(601) 366-1400
(601) 366-8167
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
16006
MS
Other
Enumeration date
12/02/2005
Last updated
07/08/2007
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