Healthcare Provider Details

I. General information

NPI: 1952325557
Provider Name (Legal Business Name): BLANCHARD FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 N COUNCIL AVE SUITE 1
BLANCHARD OK
73010-8045
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-485-9321
  • Fax: 405-485-3154
Mailing address:
  • Phone: 405-485-9321
  • Fax: 405-485-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG L TERRELL
Title or Position: SR VP, COO
Credential:
Phone: 405-307-1000