Provider Demographics
NPI:1164430385
Name:BLANCHAR, RICHARD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:BLANCHAR
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 W TRADEWINDS AVE
Mailing Address - Street 2:THE THIRD FLOOR
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4463
Mailing Address - Country:US
Mailing Address - Phone:954-776-6992
Mailing Address - Fax:954-776-6969
Practice Address - Street 1:4401 W TRADEWINDS AVE
Practice Address - Street 2:THE THIRD FLOOR
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4463
Practice Address - Country:US
Practice Address - Phone:954-776-6992
Practice Address - Fax:954-776-6969
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL42534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45031Medicare PIN
FLD62462Medicare UPIN
FL45031Medicare ID - Type Unspecified