Individual
MICHAEL GREGORY BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 15TH AVE SW STE C, PUYALLUP, WA 98371-7495
(253) 841-4243
(253) 864-9452
Mailing address
201 15TH AVE SW STE C, PUYALLUP, WA 98371-7495
(253) 841-4243
(253) 864-9452
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00019306
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008895
—
WA
01
—
110008458
RAILROAD MEDICARE
—
01
—
BL4674
REGENCE
WA
Enumeration date
08/03/2006
Last updated
07/18/2019
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