Healthcare Provider Details

I. General information

NPI: 1740212737
Provider Name (Legal Business Name): SUSAN A BLANCHARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 HIGHWAY 304
CALERA AL
35040-5540
US

IV. Provider business mailing address

206 HIGHWAY 304
CALERA AL
35040-5540
US

V. Phone/Fax

Practice location:
  • Phone: 205-668-0626
  • Fax: 205-668-4564
Mailing address:
  • Phone: 205-668-0626
  • Fax: 205-668-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16435
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18897
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: