Individual
DUSTIN PATRICK BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
02005674B
IN
207VX0000X
Obstetrics Physician
Primary
02005674A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028633
—
IN
Enumeration date
02/20/2015
Last updated
03/25/2020
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