Blackham, Kerry Alan

Blackham, Kerry Alan is an sole proprietor health care provider with primary practice located at 503 W Pine St , Philip SD 57567-0550. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Blackham, Kerry Alan can be contacted via phone (605) 859-2566.

Contact Information

Primary practice address
503 W Pine St Philip SD 57567-0550
Phone: (605) 859-2566
Fax: (605) 859-2948
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 9452 South Dakota

Profile Details

NPI number 1922014273
LBN Legal business name Blackham, Kerry Alan
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 31st, 2006
Last updated Jan 9th, 2019 - about 6 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 1922014273 NPPES
South Dakota MEDICAID S110986

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