Provider Demographics
NPI:1316906548
Name:BLACKWOOD, DON (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2309
Mailing Address - Country:US
Mailing Address - Phone:662-843-2721
Mailing Address - Fax:
Practice Address - Street 1:803 1ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2309
Practice Address - Country:US
Practice Address - Phone:662-843-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00233159OtherMEDICARE RAILROAD
MS00115094Medicaid
MSP00233159OtherMEDICARE RAILROAD
MS082945449Medicare PIN