Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | C10004901 | DE |
NPI | 1033200084 |
---|---|
Provider Name | Dr. Ray A Blackwell |
First Address | Newark, DE 19718-0001 |
Second Address | Newark, DE 19718-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 24/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000766101 | (05) | DE |
G09357 | (02) | DE |