Individual
ROYCE BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401-3979
(207) 907-3650
(207) 907-3660
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1855
ME
363AS0400X
Surgical Physician Assistant
—
ME
Other
Enumeration date
08/22/2018
Last updated
02/03/2022
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