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General NPI Number Information
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NPI Number | 1215068556
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Entity Type | Individual
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Provider Name | REX ANDREW BLUNCK P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4000 TULIP TREE DR SS-I
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City | PRINCETON
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State | IN
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Zip | 47670-2300
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Country | US
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Telephone | 812-387-2922
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Fax | 812-387-2045
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Provider Business Mailing Address
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Address Line | 1932 S LAKEWOOD HLS
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City | FRANCISCO
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State | IN
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Zip | 47649-9045
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Country | US
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Telephone | 812-782-9292
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Fax | 812-387-2045
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10000288A
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License Number State | IN
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