Jacob Blackmon, CCP
Jacob Blackmon, CCP is a Perfusionist in Plymouth, Michigan. Licensed in Texas. Registered with an NPI since 2024.
- Licensed in
- TX
- In the registry since
- 2024
Practice location Address checks out
45211 Helm StPlymouth, MI 48170
Phone: (480) 777-0900
Fax: (480) 777-1345
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Perfusionist (primary) | Taxonomy 242T00000X · Licence 199052 (TX) |
|---|
Record details
| NPI number | 1053130930 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | CCP |
| Sole proprietor | No |
| NPI enumerated | October 7, 2024 |
| Last updated in NPPES | June 26, 2026 |
| Certification date | June 26, 2026 |
| Mailing address | 45211 Helm St., Plymouth, MI 48170 |
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