MATTHEW LEE BLACKBURN (NPI# 1811213572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811213572 |
| Entity Type | Individual |
| Full Name | MATTHEW LEE BLACKBURN |
| Credential | DO |
| Practice Address |
3520 Nw Centre Dr Fort Worth TX 76135-3612 |
| Mailing Address |
Po Box 9101 Coppell TX 75019-9494 |
| Practice Telephone | 8173752100 |
| Practice Fax Number | 8172370022 |
| Mailing Telephone | 9727457500 |
| Mailing Fax Number | 9727454336 |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2014-05-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | N5512 | TX | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376076828 | Matthew Blackburn | Student in an Organized Health Care Education/Training Program | 3800 Reservoir Rd Nw, Department of Medicine, Washington, DC 20007-2113 | 2017-04-11 |
| 1053706127 | Matthew Lynn Blackburn | Emergency Medicine | 121 Dekalb Ave, Brooklyn, NY 11201-5425 | 2015-04-05 |
| 1346681236 | Matthew Blackburn | Pharmacist | 1000 S Limestone, Lexington, KY 40506-0007 | 2013-07-09 |
| Street Address |
3520 NW CENTRE DR |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76135-3612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225278583 | Rehan Husain Ali | Family Medicine | 3520 Nw Centre Dr, Fort Worth, TX 76135-3612 | 2009-02-26 |
| 1144771882 | Ami Daughrity | Physician Assistant | 3520 Nw Centre Dr, Fort Worth, TX 76135-3612 | 2016-10-18 |
| 1114260981 | Anuradha Namuduri | Family Medicine | 3520 Nw Centre Dr, Fort Worth, TX 76135-3612 | 2013-03-31 |
| 1548581697 | Diana Janett Alvarado | Physician Assistant | 3520 Nw Centre Dr, Fort Worth, TX 76135-3612 | 2010-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992283501 | Sung Ryel Choi | Dentist | 6014 Azle Ave # 100, Lake Worth, TX 76135 | 2018-08-06 |
| 1750882056 | Kandess Klein | Licensed Vocational Nurse | 8825 Claiborn St, Lakeside, TX 76135 | 2018-02-22 |
| 1841791258 | Robyn Rich | Technician | 5104 Prestwick Drive, Fort Worth, TX 76135 | 2018-02-22 |
| 1598207821 | Young Men's Christian Association of Metropolitan Fort Worth | Health Educator | 5315 Boat Club Rd, Fort Worth, TX 76135 | 2016-11-17 |
| 1558818534 | Clearfork Academy Lp | Substance Abuse Rehabilitation Facility | 7820 Hanger Cut Off, Fort Worth, TX 76135 | 2016-09-07 |
| 1316300999 | National Vision, Inc. | Technician/Technologist | 6014 Azle Ave, Ste 200, Lake Worth, TX 76135 | 2016-04-01 |
| 1457647570 | Cynthia Rosaline Witt | Optometrist | 6014 Azle Avenue, Suite 300, Lake Worth, TX 76135 | 2011-06-27 |
| 1316134125 | Home Town Dental,pa | Dentist | 6332 Lake Worth, Lake Worth, TN 76135 | 2007-09-26 |
| 1790984789 | Jonathan Nicholas Valamides | Optometrist | 6060 Azle Ave. Suite 500, Lake Worth, TX 76135 | 2007-07-11 |
| 1457570053 | Dawn Denise Ezelle | Occupational Therapy Assistant | 3400 Marine Drive, Fort Worth, TX 76135 | 2007-04-24 |
| Find all providers in zip 76135 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184020 | Kara Fenceroy | Family Medicine | 5425 Rolling Meadows Dr, Fort Worth, TX 76123-2836 | 2020-11-03 |
| 1003416207 | Adeline Galvez | Family Medicine | 1300 W Terrell Ave Ste 270, Fort Worth, TX 76104-2820 | 2020-10-27 |
| 1952870354 | Nancy Carolina Nicoloso | Family Medicine | 6302 Lake Worth Blvd Ste A3963, Fort Worth, TX 76135-3607 | 2018-11-15 |
| 1245717586 | Julia Dubose | Family Medicine | 4100 Heritage Trace Pkwy Ste 116, Fort Worth, TX 76244 | 2018-07-19 |
| 1609307115 | Yara Hamade Gonzales | Family Medicine | 4701 Bryant Irvin Rd, Fort Worth, TX 76132-3603 | 2017-03-26 |
| 1558732321 | Andres Morgado Perez | Family Medicine | 1325 Pennsylvania Ave Ste 750, Fort Worth, TX 76104-2168 | 2015-10-19 |
| 1114304805 | Davis Wellness Ltd LLP | Family Medicine | 3750 S. University Dr., Suite 201, Fort Worth, TX 76109-3701 | 2015-05-01 |
| 1902298417 | Jack Lynwood Judson, Md | Family Medicine | 1800 Malibar Rd, Fort Worth, TX 76116-1834 | 2015-02-21 |
| 1104243468 | Henry Dollahite | Family Medicine | 6205 Locke Ave, Fort Worth, TX 76116-4636 | 2014-03-25 |
| 1447676689 | Janet Shackelford | Family Medicine | 5001 Golden Triangle Blvd, # 1024, Fort Worth, TX 76244 | 2014-03-12 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76135 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.