Blackburn, Tristan Dee
Blackburn, Tristan Dee is an individual health care provider with primary practice located at 3991 Dutchmans Ln Ste 208 , Louisville KY 40207-4723. She recently has only one registered license in Allopathic & Osteopathic Physicians / Rheumatology, which is considered as her primary health care specialty. Blackburn, Tristan Dee can be contacted via phone (502) 899-6061.Contact Information
Primary practice address
3991 Dutchmans Ln Ste 208
Louisville KY 40207-4723
Phone: (502) 899-6061
Fax: (502) 899-6127
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Rheumatology | 207RR0500X | 46118 | Kentucky |
Profile Details
| NPI number | 1417176249 |
|---|---|
| LBN Legal business name | Blackburn, Tristan Dee |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 24th, 2007 |
| Last updated | Nov 17th, 2021 - about 4 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 | 1417176249 | NPPES |
| Kentucky | MEDICAID | 7100252740 | |
| Kentucky | MEDICAID | 201069110 | |
| Kentucky | Other | 50052639 |
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