Individual
DR. MICHAEL BENDELE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6124 W PARKER RD, SUITE 530, PLANO, TX 75093-8122
(214) 778-1075
(214) 778-1237
Mailing address
6124 W PARKER RD, SUITE 530, PLANO, TX 75093-8122
(214) 778-1075
(214) 778-1237
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
311912
LA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
K0266
TX
207RP1001X
Pulmonary Disease Physician
Primary
01081457A
IN
207RP1001X
Pulmonary Disease Physician
K0266
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311912
STATE LICENSE
LA
Enumeration date
08/17/2005
Last updated
10/11/2022
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