Provider Demographics
NPI:1629011010
Name:BLACKBURN, DARIN G (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:G
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3908 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2188
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:253-864-8954
Practice Address - Street 1:11216 SUNRISE BLVD E
Practice Address - Street 2:# 3-106
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-864-8954
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9868BLOtherREGENCE RIDER
WA8299778Medicaid
WA0159725OtherLABOR AND INDUSTRIES
WA7772362OtherAETNA
WA8934627OtherLABOR AND INDUSTRIES VOC
WA080189997OtherMEDICARE RAIL ROAD
WA8934627OtherLABOR AND INDUSTRIES VOC