DR. FRED BLACKLEDGE M.D. NPI 1003890179

NPI Information

  • NPI: 1003890179
  • Provider Name: DR. FRED BLACKLEDGE, M.D.
  • Classification: Plastic Surgery - 208200000X
  • Entity Type: Individual
  • Address: 764 LAKELAND DR
    JACKSON, MS
    ZIP 39216
  • Phone: (601) 981-3033

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NPI Details

DR. Fred Blackledge, M.D. is a plastic surgery in Jackson, MS. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. DR. Fred Blackledge, M.D. NPI is 1003890179. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

764 LAKELAND DR
JACKSON, MS
ZIP 39216-617
Phone: (601) 981-3033
Fax: (601) 982-8132

The enumeration date for this NPI number is 12/2/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208200000XPlastic Surgery16006MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H86323MEDICARE UPINMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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