Individual
DR. THERON BLICKENSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
709 CLANDON DR, KINGSPORT, TN 37660-5036
(423) 378-3267
Mailing address
709 CLANDON DR, KINGSPORT, TN 37660-5036
(423) 378-3267
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
14559
TN
Other
Enumeration date
10/05/2007
Last updated
10/05/2007
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