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NPI Code Detail

MEDICARE: STEPHEN PAUL BLANCHARD SR. M.D.

MEDICARE: STEPHEN PAUL BLANCHARD SR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician017802LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21174524367OTHERCAQH

General Provider Information

NPI Number : 1174524367
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN PAUL BLANCHARD SR. M.D.
Provider Business Mailing Address
First Line : PO BOX 3780
Second Line :
City : TUPELO
State : MS
Zip : 38803-3780
Country : US
Telephone Number : 601-553-6810
Fax Number :
Provider Business Practice Location Address
First Line : 309 JACKSON ST
Second Line :
City : MONROE
State : LA
Zip : 71201-7407
Country : US
Telephone Number : 318-327-4105
Fax Number : 318-327-4423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/14/2020

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