Basic Information
| Provider Information | |||||||||
| NPI: | 1396847125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKMER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3080 E GENTRY WAY | ||||||||
| Address2: | STE 201 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836423013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083190497 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 191 ADDISON AVE | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833015177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087333881 | ||||||||
| FaxNumber: | 2087338441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | P118 | ID | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.