Provider Demographics
NPI:1962402446
Name:BLACKMON, ANA (MD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-4280
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-4280
Practice Address - Fax:713-790-2851
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00895531OtherRR MEDICARE
TX8CN637OtherBLUE CROSS BLUE SHIELD
TXP00330517OtherRAILROAD MEDICARE
TX8V4450OtherBLUE CROSS BLUE SHIELD
TXP00895531OtherRR MEDICARE
TX8V4450OtherBLUE CROSS BLUE SHIELD