Blackmon, Jeffrey M
Blackmon, Jeffrey M is an individual health care provider with primary practice located at 929 Sw Simpson Ave Ste 300 , Bend OR 97702-3599. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Blackmon, Jeffrey M can be contacted via phone (541) 389-7741.Contact Information
Primary practice address
929 Sw Simpson Ave Ste 300
Bend OR 97702-3599
Phone: (541) 389-7741
Fax: (541) 278-8375
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 55917 | Georgia |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD196707 | Oregon |
Profile Details
| NPI number | 1710901996 |
|---|---|
| LBN Legal business name | Blackmon, Jeffrey M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 27th, 2006 |
| Last updated | Mar 24th, 2023 - about 2 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 | 1710901996 | NPPES |
| Georgia | MEDICAID | 724476151G |
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