Healthcare Provider Details

I. General information

NPI: 1326911595
Provider Name (Legal Business Name): BLANCHARD MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 E 1600 N
MAPLETON UT
84664-4105
US

IV. Provider business mailing address

851 E 180 N
SALEM UT
84653-5543
US

V. Phone/Fax

Practice location:
  • Phone: 801-614-2400
  • Fax: 801-206-3390
Mailing address:
  • Phone: 801-614-2400
  • Fax: 801-206-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JASON BLANCHARD
Title or Position: OWNER
Credential: DPM
Phone: 660-865-9627