Individual
MADISON CLARE BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1983 BELFIELD RD, LAKE CHARLES, LA 70611-4648
(337) 912-8363
Mailing address
1983 BELFIELD RD, LAKE CHARLES, LA 70611-4648
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
04/06/2022
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