Provider Demographics
NPI:1326001652
Name:BLANCHARD, STEVEN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:M
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-336-1485
Mailing Address - Fax:870-336-1484
Practice Address - Street 1:1111 WINDOVER
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6159
Practice Address - Country:US
Practice Address - Phone:870-935-5432
Practice Address - Fax:870-935-4887
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5560207Q00000X
ARC-5560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16433000000OtherQUALCHOICE
AR101818001Medicaid
AR16433000000OtherQUALCHOICE
ARD84073Medicare UPIN