Individual
BRUCE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4137 HUNTERS PARK LN, ORLANDO, FL 32837-7669
(407) 304-1710
(407) 304-1778
Mailing address
PO BOX 522468, LONGWOOD, FL 32752-2468
(407) 389-5300
(407) 389-5363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME57535
FL
Other
Enumeration date
10/20/2005
Last updated
05/09/2011
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