Individual
JACOB BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
8200 WALNUT HILL LN, DALLAS, TX 75231-4402
(214) 345-6789
Mailing address
2106 OAKCREST CT, CORINTH, TX 76210-8855
(972) 345-5163
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
199052
TX
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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