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Individual

DR. JONATHAN EDWARD BLACKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
8000 E PRENTICE AVE, SUITE D-12, GREENWOOD VILLAGE, CO 80111-2744
(303) 795-3443
(303) 290-6317
Mailing address
8000 E PRENTICE AVE, SUITE D-12, GREENWOOD VILLAGE, CO 80111-2744
(303) 795-3443
(303) 290-6317

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
27023
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01270230
CO
01
1063746972
GROUP NPI
05
44176279
CO
Enumeration date
02/16/2007
Last updated
01/13/2010
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