Basic Information
| Provider Information | |||||||||
| NPI: | 1215954763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIDDLETON | ||||||||
| FirstName: | BLACKFORD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 W END AVE | ||||||||
| Address2: | VANDERBILT UNIVERSITY MEDICAL CENTER | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158733705 | ||||||||
| FaxNumber: | 6153225610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 MEDICAL CENTER DR | ||||||||
| Address2: | VANDERBILT UNIVERSITY MEDICAL CENTER | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153225000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 213036 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 50052 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.