| David C Blackmon,phd,psych Svc | |
|
482 Jacksonville Dr Jacksonville Beach FL 32250-3812 | |
| (904) 333-3389 | |
| (904) 246-6703 |
| Full Name | David C Blackmon,phd,psych Svc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 482 Jacksonville Dr, Jacksonville Beach, Florida |
| Authorized Official Name and Position | David C Blackmon (PRESIDENT) |
| Authorized Official Contact | 9043333389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David C Blackmon,phd,psych Svc 482 Jacksonville Dr Jacksonville Beach FL 32250-3812 Ph: () - | David C Blackmon,phd,psych Svc 482 Jacksonville Dr Jacksonville Beach FL 32250-3812 Ph: (904) 333-3389 |
| NPI Number | 1538438270 |
|---|---|
| Provider Enumeration Date | 12/27/2011 |
| Last Update Date | 01/03/2012 |
| Medicare PECOS PAC ID | 0749457745 |
|---|---|
| Medicare Enrollment ID | O20120113000635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538438270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PY4360 (Florida) | Primary |
| Provider Name | David C Blackmon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144338211 PECOS PAC ID: 6002083003 Enrollment ID: I20120113000658 |
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