Individual
KERRY ALAN BLACKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
503 W PINE ST, PHILIP, SD 57567-0550
(605) 859-2566
(605) 859-2948
Mailing address
503 WEST PINE, PHILIP, SD 57567-0550
(605) 859-2566
(605) 859-2948
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
9452
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S110986
—
SD
Enumeration date
07/31/2006
Last updated
01/09/2019
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