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1184867574
DAVID MAURICE BLACKWELL
PROVO, UT
NPI
1184867574
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: UT 5505835-1206)
Enumeration Date
2009-04-14
Last Update Date
2023-11-27
Business Address
DAVID MAURICE BLACKWELL PA-C
1055 N 500 W STE 207
PROVO, UT 84604-3305
Phone number: 801-375-4263
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Mailing Address
DAVID MAURICE BLACKWELL PA-C
1055 N 500 W CREDENTIALING DEPARTMENT
PROVO, UT 84604-3305
Phone number: 801-354-8225
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