Provider Demographics
NPI:1518337435
Name:BLACKBURN, JAMES DAVID X (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:BLACKBURN
Suffix:X
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 1:19499 STATE HWY. 49
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-5251
Mailing Address - Country:US
Mailing Address - Phone:903-665-8996
Mailing Address - Fax:903-665-8996
Practice Address - Street 1:19499 STATE HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-5251
Practice Address - Country:US
Practice Address - Phone:903-665-8996
Practice Address - Fax:903-665-8996
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8902208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13500Medicare UPIN