Healthcare Provider Details

I. General information

NPI: 1780396234
Provider Name (Legal Business Name): QUIN PATRICK BLANKENSHIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 COUNTY ROAD 2510
LENOX MO
65541-9348
US

IV. Provider business mailing address

3191 COUNTY ROAD 2510
LENOX MO
65541-9348
US

V. Phone/Fax

Practice location:
  • Phone: 573-453-4941
  • Fax:
Mailing address:
  • Phone: 573-453-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026022111
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: