Organization
BLACKMUN FOOTCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNESSA RENEE' BLACKMUN DPM (OWNER)
(502) 418-4809
Entity
Organization
Contact information
Practice address
2608 N 14TH ST, SAINT LOUIS, MO 63106-3913
(314) 932-1570
Mailing address
PO BOX 23359, SAINT LOUIS, MO 63156-3359
(314) 932-1570
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2010035799
MO
Other
Enumeration date
03/29/2011
Last updated
04/05/2016
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