Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 057150 | GA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 29700 | SC |
Y | 2081P2900X | Pain Medicine | 29700 | SC |
N | 2081P2900X | Pain Medicine | 53281 | TN |
NPI | 1407887201 |
---|---|
Provider Name | Dr. Robert J Blackwell |
First Address | North Charleston, SC 29406-7109 |
Second Address | North Charleston, SC 29406-7109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 13/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297002 | (05) | SC |
I17540 | (02) | |
I17540 | (02) | GA |