MEDICARE: DR. JAMES D. BLANKENSHIP 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
1	207Q00000X	Family Medicine Physician	2003023198	MO

General Provider Information

NPI Number	:	1609900422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D. BLANKENSHIP M.D.

Provider Business Mailing Address
First Line	:	620 MERAMEC VIEW DR
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-3710
Country	:	US
Telephone Number	:	636-587-2742
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 MARKET ST STE 600
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1826
Country	:	US
Telephone Number	:	314-342-7745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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