1760581888 NPI number — DR. PATRICK A BLANCHARD M.D.

Table of content: DR. PATRICK A BLANCHARD M.D. (NPI 1760581888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760581888 NPI number — DR. PATRICK A BLANCHARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHARD
Provider First Name:
PATRICK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760581888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5534 BIRCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32570-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-390-7175
Provider Business Mailing Address Fax Number:
850-390-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5534 BIRCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32570-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-390-7175
Provider Business Practice Location Address Fax Number:
850-390-7174
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  04 24112 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 39333 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME123648 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QH0002X , with the licence number: ME123648 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100182460B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017313100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14K9W . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102202 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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