Organization
MED EX PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J. BLACKBURN DO (PRESIDENT)
(800) 824-2543
Entity
Organization
Contact information
Practice address
705 WASHINGTON ST, RAVENSWOOD, WV 26164-1729
(800) 824-2543
(330) 862-2356
Mailing address
705 WASHINGTON ST, RAVENSWOOD, WV 26164-1729
(800) 824-2543
(330) 862-2356
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/18/2006
Last updated
10/16/2007
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