Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | DO.2305 | AL |
NPI | 1194141333 |
---|---|
Provider Name | Dr. Michael Blackmer |
First Address | Mobile, AL 36689-6144 |
Second Address | Foley, AL 36535-2282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 28/07/2020 |