MEDICARE: ALLISON A BLANCHARD MD

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	17171	OK

General Provider Information

NPI Number	:	1740234541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON A BLANCHARD MD

Provider Business Mailing Address
First Line	:	PO BOX 5387
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-5387
Country	:	US
Telephone Number	:	866-321-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 MORRIS DR
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6429
Country	:	US
Telephone Number	:	918-756-3410
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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