Provider Demographics
NPI:1265428551
Name:BLACKBURN, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:913 S COLLEGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3060
Mailing Address - Country:US
Mailing Address - Phone:337-232-2833
Mailing Address - Fax:337-234-4038
Practice Address - Street 1:913 S COLLEGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3060
Practice Address - Country:US
Practice Address - Phone:337-232-2833
Practice Address - Fax:337-234-4038
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0087282084F0202X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA50306Medicare ID - Type Unspecified