Individual
JERRY BLACKLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6560 FANNIN ST, SUITE 900, HOUSTON, TX 77030-2761
(713) 441-3800
Mailing address
6560 FANNIN ST, SUITE 900, HOUSTON, TX 77030-2761
(713) 441-3800
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
G9066
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8EA863
BLUE CROSS BLUE SHIELD
TX
01
—
8GD848
BCBS
TX
01
—
8R9781
BLUE CROSS BLUE SHIELD
TX
01
—
P00216844
RAILROAD MEDICARE
TX
01
—
P01331480
RR MEDICARE
TX
Enumeration date
07/12/2006
Last updated
01/24/2017
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