ETHAN WADE BLACKBURN

LOUISVILLE, KY
NPI1538387360
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207XS0106X Orthopaedic Surgery, Hand Surgery
(Licence: KY  45826)
Additional Taxonomies207X00000X Orthopaedic Surgery
(Licence: KY  45826)
207X00000X Orthopaedic Surgery
(Licence: IN  01071401B)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2007-04-24
Last Update Date2021-01-12
Business Address
ETHAN WADE BLACKBURN MD
315 E BROADWAY STE 195
LOUISVILLE, KY 40202-3700
Phone number: 502-629-4263
Mailing Address
ETHAN WADE BLACKBURN MD
PO BOX 776351
CHICAGO, IL 60677-6351
Phone number: 502-588-9490