MEDICARE: ANTHONY I BLANCHARD DPM LLC

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
1	213EP1101X	Primary Podiatric Medicine Podiatrist	PD140R	LA

General Provider Information

NPI Number	:	1255735320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY I BLANCHARD DPM LLC

Provider Business Mailing Address
First Line	:	232 SAINT PIERRE BLVD
Second Line	:
City	:	CARENCRO
State	:	LA
Zip	:	70520-3914
Country	:	US
Telephone Number	:	337-356-3905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 GARY DR
Second Line	:
City	:	BREAUX BRIDGE
State	:	LA
Zip	:	70517-3448
Country	:	US
Telephone Number	:	337-806-3349
Fax Number	:	337-909-2216

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. ANTHONY ISAAC BLANCHARD
Credential	:	D.P.M.
Telephone Number	:	337-356-3905

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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