Individual
CASEY BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 THE ALAMEDA, SAN JOSE, CA 95126-1136
(408) 261-7777
(408) 259-2273
Mailing address
614 N 11TH ST, SAN JOSE, CA 95112-3220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
111097739
TN
Other
Enumeration date
12/14/2014
Last updated
12/14/2014
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