Provider Demographics
NPI:1376543553
Name:BLACKBURN, JAMES ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58662
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8662
Mailing Address - Country:US
Mailing Address - Phone:281-747-9313
Mailing Address - Fax:281-724-0487
Practice Address - Street 1:500 N KOBAYASHI STE C
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4722
Practice Address - Country:US
Practice Address - Phone:281-747-9313
Practice Address - Fax:281-724-0487
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N3899OtherBCBS
TX2036733-01Medicaid
TX8A7067Medicare PIN
TX2036733-01Medicaid