Provider Demographics
NPI:1134123706
Name:BLANCHARD, GARY WAYNE
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 ATTAKAPAS DR
Mailing Address - Street 2:STE 502
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6530
Mailing Address - Country:US
Mailing Address - Phone:337-942-9977
Mailing Address - Fax:337-942-8006
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:STE 502
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6530
Practice Address - Country:US
Practice Address - Phone:337-942-9977
Practice Address - Fax:337-942-8006
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09513R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1955124Medicaid
LA1955124Medicaid