Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 13021 | OK |
NPI | 1568493179 |
---|---|
Provider Name | Judith Louise Blackwell |
First Address | Tulsa, OK 74133-5708 |
Second Address | Tulsa, OK 74133-5708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E34891 | (02) |