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Individual

RONALD L BLACKMORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
101 MED TECH PKWY STE 100, JOHNSON CITY, TN 37604-4006
(423) 794-1800
(423) 794-1801
Mailing address
101 MED TECH PARKWAY, STE 100, JOHNSON CITY, TN 37604
(423) 794-1800
(423) 794-1801

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD31358
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3117550
BCBS
TN
05
3839980
TN
01
TN01N8
JOHN DEERE
TN
Enumeration date
04/17/2006
Last updated
07/21/2022
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