Provider Demographics
NPI:1831154988
Name:BLACKBURN, RAYMOND C (MD)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8200 BROOKRIVER DR
Mailing Address - Street 2:STE N705
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4069
Mailing Address - Country:US
Mailing Address - Phone:214-630-5256
Mailing Address - Fax:214-630-2251
Practice Address - Street 1:8200 BROOKRIVER DR
Practice Address - Street 2:STE N705
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4069
Practice Address - Country:US
Practice Address - Phone:214-630-5256
Practice Address - Fax:214-630-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF2557207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C13504Medicare UPIN