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Contact Information

FRED BLACKLEDGE, MD
764 LAKELAND DR
JACKSON, MS39216-4617
 Phone: 601-981-3033
 Fax: 601-982-8132
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Plastic Surgery

208200000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for FRED BLACKLEDGE · (Male)

NPI # 1003890179
Status Active
Credentials MD
Entity Individual
Enumeration date 12/02/2005
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • MS License # 16006
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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