Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Thomas Blackwell Jr., MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1003666421

Thomas Blackwell Jr., MD is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 655-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1003666421
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 26, 2024
Last updated in NPPESMarch 26, 2024
Certification dateMarch 26, 2024
Mailing address530 Ne Glen Oak Ave, Peoria, IL 61637-0001

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