Individual
CAMILLE DENISE BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2405 W MISSOURI AVE, MIDLAND, TX 79701-6800
(432) 697-1061
(432) 697-7089
Mailing address
2405 W MISSOURI AVE, MIDLAND, TX 79701-6800
(432) 697-1061
(432) 697-7089
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
33297
AL
208600000X
Surgery Physician
Primary
Q5158
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363823103
—
TX
Enumeration date
04/20/2009
Last updated
01/06/2023
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