Healthcare Provider Details

I. General information

NPI: 1760581888
Provider Name (Legal Business Name): PATRICK A BLANCHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 BIRCH ST
MILTON FL
32570-2802
US

IV. Provider business mailing address

5534 BIRCH ST
MILTON FL
32570-2802
US

V. Phone/Fax

Practice location:
  • Phone: 850-390-7175
  • Fax: 850-390-7174
Mailing address:
  • Phone: 850-390-7175
  • Fax: 850-390-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04 24112
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39333
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME123648
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME123648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: