Individual
JOEL M BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3916 S PROVIDENCE RD STE 101, COLUMBIA, MO 65203-7152
(573) 882-1662
(573) 882-4096
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2003004595
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116134
BLUE CROSS/BLUE SHIELD
—
05
—
209166909
—
MO
Enumeration date
11/10/2006
Last updated
08/16/2022
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