Healthcare Provider Details

I. General information

NPI: 1245202274
Provider Name (Legal Business Name): JAMES BLAIR BLANKENSHIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2793 E MILLENNIUM SUITE 1
FAYETTEVILLE AR
72703-6522
US

IV. Provider business mailing address

2793 E MILLENNIUM SUITE 1
FAYETTEVILLE AR
72703-6522
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-9025
  • Fax: 479-582-1572
Mailing address:
  • Phone: 479-582-9025
  • Fax: 479-582-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberC7058
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: