Individual
DR. SARA MARIE GENUTIS BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2006015934
MO
208000000X
Pediatrics Physician
Primary
56809
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002495187
—
GA
05
—
1265602478
—
IA
01
—
175150022
MEDICARE
—
Enumeration date
03/04/2008
Last updated
12/23/2014
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