Provider Demographics
NPI:1538462817
Name:BLACKMON, BRANDY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 56751
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77256-6751
Mailing Address - Country:US
Mailing Address - Phone:713-850-7303
Mailing Address - Fax:713-850-7302
Practice Address - Street 1:1111 POST OAK BLVD
Practice Address - Street 2:SUITE #382
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3297
Practice Address - Country:US
Practice Address - Phone:713-850-7303
Practice Address - Fax:713-850-7302
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver