Provider Demographics
NPI:1659466837
Name:BLANCHET, WILLIAM LAWSON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAWSON
Last Name:BLANCHET
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 1:2880 FOLSOM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3739
Mailing Address - Country:US
Mailing Address - Phone:303-327-7047
Mailing Address - Fax:303-443-7168
Practice Address - Street 1:2880 FOLSOM ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3739
Practice Address - Country:US
Practice Address - Phone:303-327-7047
Practice Address - Fax:303-443-7168
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO25352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01253525Medicaid
CO25352OtherCOLORADO MED EXAMINERS
AB2227317OtherDEA
AB2227317OtherDEA
E60012Medicare UPIN
CO25352OtherCOLORADO MED EXAMINERS
COC807507Medicare PIN