Individual
NATHAN THOMAS BLACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(509) 899-8730
Mailing address
3401 W GORE BLVD, LAWTON, OK 73505-6332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6614
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/28/2018
Last updated
04/15/2022
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