Provider Demographics
NPI:1568493179
Name:BLACKWELL, JUDITH LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 S 101ST EAST AVE
Mailing Address - Street 2:STE 350
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5708
Mailing Address - Country:US
Mailing Address - Phone:918-293-6200
Mailing Address - Fax:918-293-6245
Practice Address - Street 1:9001 S 101ST EAST AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5708
Practice Address - Country:US
Practice Address - Phone:918-293-6200
Practice Address - Fax:918-292-6245
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13021207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
249425103Medicare ID - Type Unspecified
E34891Medicare UPIN