MEDICARE: DR. JOE HARRY BLANKSON M.D.

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	207Q00000X	Family Medicine Physician	00011655	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	D074	OTHER	AL	MEDICARE GROUP NUMBER
3	1942235825	OTHER	AL	MEDICARE GROUP PAYEE NPI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	051036526	OTHER	AL	BLUE CROSS BLUE SHIELD
5	1508844184	OTHER		NPI

General Provider Information

NPI Number	:	1508844184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE HARRY BLANKSON M.D.

Provider Business Mailing Address
First Line	:	1700 AVENUE E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1543
Country	:	US
Telephone Number	:	205-788-3321
Fax Number	:	205-241-5260

Provider Business Practice Location Address
First Line	:	1700 AVENUE E
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1543
Country	:	US
Telephone Number	:	205-788-3321
Fax Number	:	205-241-5260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/02/2010

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Directions to “ DR. JOE HARRY BLANKSON M.D.” Practice Location

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