Healthcare Provider Details

I. General information

NPI: 1871099408
Provider Name (Legal Business Name): BLAKE THOMAS BLANCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S TYLER ST STE 100
COVINGTON LA
70433-2353
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2234
  • Fax:
Mailing address:
  • Phone: 225-767-0847
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number433758
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: