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General NPI Number Information
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NPI Number | 1013994342
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Entity Type | Individual
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Provider Name | JOHN DAVID BLANKENSHIP DO
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 401 LOWELL DR SE STE 14
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3738
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Country | US
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Telephone | 256-534-7235
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Fax | 256-534-7268
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Provider Business Mailing Address
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Address Line | 420 LOWELL DR SE STE 103
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3755
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Country | US
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Telephone | 256-535-5940
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Fax | 256-535-5954
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02709
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO630
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License Number State | AL
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