Organization
MICHAEL G. BLACKBURN, M.D. , INC. P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL G. BLACKBURN M.D. (OWNER)
(253) 841-4243
Entity
Organization
Contact information
Practice address
201 15TH AVE SW STE C, PUYALLUP, WA 98371-7495
(253) 841-4243
(253) 864-9452
Mailing address
201 15TH AVE SW STE C, PUYALLUP, WA 98371-7495
(253) 841-4243
(253) 864-9452
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD00019306
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008895
—
WA
01
—
110008458
RAILROAD MEDICARE
—
01
—
BL4674
REGENCE
WA
Enumeration date
05/15/2008
Last updated
07/23/2019
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