Individual
BLEN D BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3688 VETERANS MEMORIAL DR., SUITE 200, HATTIESBURG, MS 39401
(601) 554-7400
(601) 554-7499
Mailing address
3688 VETERANS MEMORIAL DR., SUITE 200, HATTIESBURG, MS 39401
(601) 554-7400
(601) 554-7499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00132
MS
Other
Enumeration date
06/04/2010
Last updated
08/20/2013
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