Individual
DR. JACK C BLACKSTONE, JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 BRECKENRIDGE ST, SUITE 200, OWENSBORO, KY 42303-0839
(270) 926-3700
(270) 926-2114
Mailing address
1000 BRECKENRIDGE ST, SUITE 200, OWENSBORO, KY 42303-0839
(270) 926-3700
(270) 926-2114
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
18142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64181423
—
KY
Enumeration date
09/29/2005
Last updated
07/08/2010
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