Taylor Loren Blackburn, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101271372 Issued in VA

Practice address

307 Boatner Rd Ste 114
Eglin Afb, FL 32542-1302

Phone

(850) 883-8600

NPI assigned

Apr 5, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1174085377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "TAYLOR",
        "middle_name": "LOREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-05",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101271372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell David Bienias, D.M.D
• Stephen Thomas Biggs, IDMT
• Bradie N Bishop, M.D.
• Jennifer Marie Bishop, LCSW
• Lance Michael Black, M.D.
• Stephanie Ann Blubaugh, PA
• Eugenia Boldyreva, FNP-C
• Jessica Noelle Bolton, M.D.
• Mikel Elias Borup, DO
• Julie M Bosch, NP

• Pediatrics Physician in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.