Individual
WILLIAM BLAKE MCKIBBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16 IVY RIDGE LN STE 130, FISHERSVILLE, VA 22939-2354
(540) 332-5909
(540) 332-5910
Mailing address
16 IVY RIDGE LN STE 130, FISHERSVILLE, VA 22939-2354
(540) 332-5909
(540) 332-5910
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101240500
VA
208600000X
Surgery Physician
052784
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
705155309A
—
GA
Enumeration date
06/10/2005
Last updated
02/13/2020
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