Provider Demographics
NPI:1770562423
Name:BLACKWOOD, BEN (HS)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 49952
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9483
Mailing Address - Country:US
Mailing Address - Phone:787-729-2305
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER 5 CALLE LA PUNTILLA
Practice Address - Street 2:USCG BASE SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-729-2305
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other