Provider Demographics
NPI:1578678454
Name:BLANNING, ADAM (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BLANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 E 17TH AVE # 233
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1813
Mailing Address - Country:US
Mailing Address - Phone:720-404-9199
Mailing Address - Fax:720-941-0234
Practice Address - Street 1:3500 E 17TH AVE # 233
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1813
Practice Address - Country:US
Practice Address - Phone:720-404-9199
Practice Address - Fax:720-941-0234
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92831Medicare UPIN
509638Medicare ID - Type Unspecified