Provider Demographics
NPI:1245766641
Name:BLANCHARD, JOSHUA DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DOUGLAS
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 OAK LN
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2146
Mailing Address - Country:US
Mailing Address - Phone:517-303-3986
Mailing Address - Fax:
Practice Address - Street 1:2302 OAK LN
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2146
Practice Address - Country:US
Practice Address - Phone:517-303-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022714207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016022714OtherMISSOURI LICENSE