Individual
TIMOTHY L BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17067 S OUTER RD, SUITE 200, BELTON, MO 64012-2165
(816) 348-4281
(816) 348-4271
Mailing address
2316 E MEYER BLVD STE 509, KANSAS CITY, MO 64132-1136
(816) 276-4800
(816) 523-1425
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
R2P33
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060066709
RAILROAD MEDICARE
MO
05
—
1558325605
—
MO
01
—
17891028
BCBS-KC
MO
Enumeration date
04/14/2006
Last updated
09/05/2023
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