Provider Demographics
NPI:1750337861
Name:BLACKWELL, LINDA J (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:873 HINOTES CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9043
Mailing Address - Country:US
Mailing Address - Phone:360-318-9705
Mailing Address - Fax:360-318-8735
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-671-4402
Practice Address - Fax:360-671-9463
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00027685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8925061OtherLABOR & INDUSTRIES (CV)
WA07780OtherREGENCE BLUESHIELD
WA1061548Medicaid
WA0128739OtherLABOR & INDUSTRIES (REG)
WAF04594Medicare UPIN
WAGAB08988Medicare PIN