Healthcare Provider Details

I. General information

NPI: 1134147853
Provider Name (Legal Business Name): LUCIUS BLANCHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 S PECOS RD
LAS VEGAS NV
89121-5030
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 500
DALLAS TX
75231-0928
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-1001
  • Fax: 702-436-7999
Mailing address:
  • Phone: 702-360-2100
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number3617
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: