Provider Demographics
NPI:1386221265
Name:VALISEMD INC
Entity Type:Organization
Organization Name:VALISEMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-390-7173
Mailing Address - Street 1:9072 IRON GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-7759
Mailing Address - Country:US
Mailing Address - Phone:850-390-7175
Mailing Address - Fax:850-390-7174
Practice Address - Street 1:9072 IRON GATE BLVD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-7759
Practice Address - Country:US
Practice Address - Phone:850-390-7173
Practice Address - Fax:850-390-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty