Individual
JOSEPH W BLACKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 PETIT BOIS ST N, JACKSON, MS 39211-6707
(601) 981-4625
(601) 981-4625
Mailing address
1900 PETIT BOIS ST N, JACKSON, MS 39211-6707
(601) 981-4625
(601) 981-4625
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
11335
MS
207R00000X
Internal Medicine Physician
Primary
MD 11335
MS
209800000X
Legal Medicine (M.D./D.O.) Physician
MD 11335
MS
Other
Enumeration date
08/29/2006
Last updated
09/11/2007
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