Provider Demographics
NPI:1568620540
Name:BLACKWELL, JEFFRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:S
Last Name:BLACKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7001 ROGERS AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4073
Mailing Address - Country:US
Mailing Address - Phone:479-314-4650
Mailing Address - Fax:479-452-9459
Practice Address - Street 1:7001 ROGERS AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4073
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-9459
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2014-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-7921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease