Michael Gregory Blackburn, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD00019306 Issued in WA

Practice address

201 15TH Ave SW Ste C
Puyallup, WA 98371-7495

Phone

(253) 841-4243

Fax

(253) 864-9452

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Michael G Blackburn Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1063429652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 15TH AVE SW STE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717495",
            "telephone_number": "253-841-4243",
            "fax_number": "253-864-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 15TH AVE SW STE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717495",
            "telephone_number": "253-841-4243",
            "fax_number": "253-864-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "MICHAEL",
        "middle_name": "GREGORY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00019306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008895",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "BL4674",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110008458",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "BLACKBURN",
            "middle_name": "G",
            "credential": "M.D., INC., P.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Julia Ann Ayala Bitton
• Erik Nels Bjarke, M.D.
• Lucinda M Black, PSS
• Megan Black, OTR/L
• Darin G Blackburn, MD
• Christopher Talmage Blacker, DMD
• Diana Lee Blacklock, LMP
• Jordyn Lee Blair, RN
• Brandy L Blake, LMP
• Will O Blankenship, M.D.

• Internal Medicine Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.