Individual
TERRANCE L BLACKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1900 BLUEGRASS AVE, SUITE 203, LOUISVILLE, KY 40215
(502) 375-0009
(502) 375-2150
Mailing address
101 HOSPITAL BLVD, JEFFERSONVILLE, IN 47130-3769
(812) 282-3899
(812) 282-4172
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
37196
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000231288
ANTHEM
—
01
—
1106100
PASSPORT
KY
01
—
1168051
PASSPORT
KY
01
—
340020112
RAILROAD MEDICARE
KY
01
—
340020112
RAILROAD MEDICARE
—
05
—
64055122
—
KY
05
—
65909285
—
KY
01
—
7616735001
CIGNA
—
01
—
7771374
AETNA
—
Enumeration date
10/05/2006
Last updated
04/20/2017
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