Individual
EDWARD B BLACKMON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1907 HIGHWAY 97 E STE 220, JOURDANTON, TX 78026-1538
(830) 769-5916
(830) 769-5917
Mailing address
1907 HIGHWAY 97 E, SUITE 220, JOURDANTON, TX 78026
(830) 769-5916
(830) 769-5917
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M0326
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171496601
—
TX
01
—
349733YLLW
MEDICARE
TX
Enumeration date
11/22/2006
Last updated
07/21/2022
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