Individual
DR. AUDREY DEANNE BLACKLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
04-34305
KS
207W00000X
Ophthalmology Physician
Primary
2012008166
MO
Other
Enumeration date
08/13/2007
Last updated
10/06/2022
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