Provider Demographics
NPI:1851422406
Name:BLACKMAN, ELIOTT S (DO)
Entity Type:Individual
Prefix:MR
First Name:ELIOTT
Middle Name:S
Last Name:BLACKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:ELIOTT
Other - Middle Name:S
Other - Last Name:BLACKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1956 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4205
Mailing Address - Country:US
Mailing Address - Phone:415-921-1446
Mailing Address - Fax:
Practice Address - Street 1:1956 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4205
Practice Address - Country:US
Practice Address - Phone:415-921-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3263204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM