Blackburn, Scott

Blackburn, Scott is an individual health care provider with primary practice located at 1340 Broad Ave Suite 240, Gulfport MS 39501-2404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Blackburn, Scott can be contacted via phone (228) 575-1200.

Contact Information

Primary practice address
1340 Broad Ave Suite 240 Gulfport MS 39501-2404
Phone: (228) 575-1200
Fax: (228) 575-1205
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 22156 Mississippi

Profile Details

NPI number 1770747081
LBN Legal business name Blackburn, Scott
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 16th, 2008
Last updated Oct 5th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770747081 NPPES
Mississippi MEDICAID 00900834

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