Provider Demographics
NPI:1124020300
Name:BLANDFORD, JOSEPH MARION JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARION
Last Name:BLANDFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-366-1090
Mailing Address - Fax:502-366-1564
Practice Address - Street 1:4402 CHURCHMAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-3100
Practice Address - Country:US
Practice Address - Phone:502-366-1090
Practice Address - Fax:502-366-1564
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050011OtherANTHEM
KY1049012OtherPASSPORT
KY020017842OtherRAILROAD MEDICARE
KYP01026548OtherMEDICARE RAILROAD
KY64201460Medicaid
KY000000050011OtherANTHEM
KY020017842OtherRAILROAD MEDICARE
KY0258601Medicare PIN