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NPI Code Detail

MEDICARE: DR. JUAN SANTIAGO BLANCH MD

MEDICARE: DR. JUAN SANTIAGO BLANCH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician07362RLA
2207R00000XInternal Medicine Physician07362RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124068127
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN SANTIAGO BLANCH MD
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line : SUITE 201
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 504-866-1336
Fax Number :
Provider Business Practice Location Address
First Line : 1125 MARGUERITE ST
Second Line :
City : MORGAN CITY
State : LA
Zip : 70380-1855
Country : US
Telephone Number : 504-866-1336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 04/11/2018

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