Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. GLENN KOONTZ BLACKBURN JR., M.D.
ActiveDR. GLENN KOONTZ BLACKBURN JR., M.D. is a Adolescent Medicine (Pediatrics) healthcare provider located in SOMERSET, Kentucky. NPI 1750351037 is currently active in the NPPES registry. Verify at CMS.
Adolescent Medicine (Pediatrics) · SOMERSET, KY
Registration Details
- NPI Number
- 1750351037
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 26, 2006 (20.577775377619 yrs)
- Last Updated
- Jul 9, 2007
- License
-
16207 (KY)
Practice Information
- Address
-
CHILDREN'S CLINIC350 LANGDON ST.SOMERSET, KY, 42503Browse KY providers · Browse ZIP 42503
- Phone
- 6066788155
- Fax
- 6066787548
- Primary Specialty
-
Adolescent Medicine (Pediatrics)
2080A0000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.