Provider Demographics
NPI:1437713849
Name:BLANCHARD, JOSHUA GREY (IDC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GREY
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 9TH AVE UNIT 711
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8943
Mailing Address - Country:US
Mailing Address - Phone:910-372-8133
Mailing Address - Fax:
Practice Address - Street 1:1441 9TH AVE UNIT 711
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8943
Practice Address - Country:US
Practice Address - Phone:910-372-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman