Individual
KEITH WILLIAM BLACKMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11312 JEFFERSON HWY, RIVER RIDGE, LA 70123-1709
(504) 464-0032
(504) 466-3440
Mailing address
PO BOX 19988, NEW ORLEANS, LA 70179-0988
(504) 464-0032
(504) 466-3440
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
10367R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679941
—
LA
Enumeration date
01/13/2006
Last updated
07/09/2007
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