Provider Demographics
NPI:1821233420
Name:BLACKWOOD, JOEL EVAN (RPA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:EVAN
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15790 S 4240 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-0556
Mailing Address - Country:US
Mailing Address - Phone:918-606-0137
Mailing Address - Fax:
Practice Address - Street 1:4500 S GARNETT RD
Practice Address - Street 2:SUITE 919
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5229
Practice Address - Country:US
Practice Address - Phone:918-728-6145
Practice Address - Fax:918-728-6146
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant