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:
Health care specialties
| Specialty | Code | License # | 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 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770747081 | NPPES |
| Mississippi | MEDICAID | 00900834 |
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