Dr. Glenn Koontz Blackburn Jr.
M.D. | Pediatric Adolescent Medicine | Male
Dr. Glenn Koontz Blackburn Jr., M.D. is a Somerset, Kentucky based Pediatric doctor with medical specialization in
Pediatric Adolescent Medicine.
Current practice location of Dr. Glenn Koontz Blackburn Jr. is
Children's Clinic, 350 Langdon St., Somerset, Kentucky - 42503. He can be contacted on phone at
606-678-8155 and fax number 606-678-7548.
Dr. Glenn Koontz Blackburn Jr. is a sole proprietor of his business.
NPI number (Unique professional ID) for Dr. Glenn Koontz Blackburn Jr. is
1750351037 which was assigned by NPPES on 26 Jan, 2006 and it was last updated on 09 Jul, 2007.
Dr. Glenn Koontz Blackburn Jr. license number is
16207 for Pediatrics Adolescent Medicine (2080A0000X) in Kentucky.
Dr. Glenn Koontz Blackburn Jr. specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Complete Profile:
Dr. Glenn Koontz Blackburn Jr. basic information including his official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Adolescent Medicine |
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| Provider Name : | Dr. Glenn Koontz Blackburn Jr. |
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| Credential : | M.D. |
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| Gender : | Male |
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Business Address:
Dr. Glenn Koontz Blackburn Jr. address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | Children's Clinic, 350 Langdon St.
Somerset, KY, 42503
United States |
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| Phone Number : | 606-678-8155 |
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| Fax Number : | 606-678-7548 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1750351037 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 26 Jan, 2006 |
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| Last Updated On : | 09 Jul, 2007 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Glenn Koontz Blackburn Jr. are as mentioned. Primary taxonomy code for Dr. Glenn Koontz Blackburn Jr., M.D. is
2080A0000X (Pediatrics Adolescent Medicine).
| Taxonomy Code | Speciality | Primary | License No. | State |
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| 2080A0000X | Pediatrics Adolescent Medicine | Yes | 16207 | KY |
Legacy Identifiers:
Other legacy medical identifiers of Dr. Glenn Koontz Blackburn Jr. such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
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| 64162076 | MEDICAID | KY | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | Children's Clinic, 350 Langdon St.
Somerset, KY, 42503
United States |
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| Phone Number : | 606-678-8155 |
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| Fax Number : | 606-678-7548 |
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Business Location:
Patients can refer following map for directions to
Dr. Glenn Koontz Blackburn Jr. practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.