Individual
GERALD THEADORE BLACKMON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1665 S MONTE VERDE DR, BEAUMONT, CA 92223-8589
(951) 663-6995
(951) 769-5513
Mailing address
1665 S MONTE VERDE DR, BEAUMONT, CA 92223-8589
(951) 663-6995
(951) 769-5513
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
A7202290
CA
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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