Individual
GENEVIEVE J.T. BLACKWELDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6526 ASHMORE LN, TYLER, TX 75703-5896
(972) 489-3005
Mailing address
6526 ASHMORE LN, TYLER, TX 75703-5896
(972) 489-3005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N2007
TX
Other
Enumeration date
05/21/2007
Last updated
10/23/2009
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