Marc Blackburn, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DN20587 Issued in FL

Practice address

8630 University Pkwy
Pensacola, FL 32514-4907

Phone

(850) 476-4815

NPI assigned

Jun 2, 2014

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

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1205248705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8630 UNIVERSITY PKWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325144907",
            "telephone_number": "850-476-4815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8630 UNIVERSITY PKWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325144907",
            "telephone_number": "850-476-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Jean Black, MS
• Taran Lavontaya Black
• Angela Chisum Blackburn, PH.D., A.R.N.P.
• Audrey Rae Blackburn
• Kaitlin Elizabeth Blackburn, DDS
• Donald L Blackmon Jr., MD
• Kevin Russell Blackmon, PT
• Stacia Blackmon
• Matthew Lewis Blair, D.O.
• Ashley Harris Blake, LPN

• Dentist in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.