Individual
DAVID MAURICE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1055 N 500 W STE 207, PROVO, UT 84604-3305
(801) 375-4263
(801) 429-8085
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5505835-1206
UT
Other
Enumeration date
04/14/2009
Last updated
11/27/2023
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