Individual
ANN E BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
608 OLD ROUTE 66, SAINT ROBERT, MO 65584-3730
(573) 336-5100
Mailing address
608 OLD ROUTE 66, SAINT ROBERT, MO 65584-3730
(573) 336-5100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2010007130
MO
207Q00000X
Family Medicine Physician
34727
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1242164
—
IA
01
—
135570022
MEDICARE PTAN
MO
05
—
1588640510
—
MO
01
—
P00837677
RAILROAD MEDICARE
MO
01
—
PO00168051
RR MEDICARE
IA
Enumeration date
12/21/2005
Last updated
01/13/2021
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