Provider Demographics
NPI:1720016496
Name:BLACKSTONE, HARRY G (DO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:G
Last Name:BLACKSTONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 GREEN SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1306
Mailing Address - Country:US
Mailing Address - Phone:813-355-4914
Mailing Address - Fax:855-547-5415
Practice Address - Street 1:7213 GREEN SLOPE DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1306
Practice Address - Country:US
Practice Address - Phone:813-355-4914
Practice Address - Fax:855-547-5415
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040598100Medicaid
080149290OtherRAILROAD MEDICARE
FL82451OtherBCBS
080149290OtherRAILROAD MEDICARE
FL040598100Medicaid