Individual
JOSEPH BRUCE BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1075 S COURT ST, STE 100, MEDINA, OH 44256-3836
(330) 722-6337
(330) 722-0481
Mailing address
1075 S COURT ST, STE 100, MEDINA, OH 44256-3836
(330) 722-6337
(330) 722-0481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
350-77002-B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2152281
—
OH
Enumeration date
06/13/2005
Last updated
01/07/2010
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