Provider Demographics
NPI:1245220110
Name:BLACKWELL, DAVID ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST # MS 8340
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-5865
Mailing Address - Country:US
Mailing Address - Phone:806-761-0770
Mailing Address - Fax:806-761-0776
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 3B100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-8340
Practice Address - Country:US
Practice Address - Phone:806-743-2340
Practice Address - Fax:806-743-1775
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE69962085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134414506Medicaid
NM44304Medicaid
NMA052OtherTRIWEST
NMX5317Medicaid
TX108700100OtherFRISTCARE COMMERCIAL
TX134414501Medicaid
TX80807ZOtherHMO BLUE
TX108700101Medicaid
NM44304OtherPRESBYTERIAN COMMERCIAL
TX80R001OtherBC/BS
OK100034690AMedicaid