Provider Demographics
NPI:1780860148
Name:BLANKEMEIER, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BLANKEMEIER
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 1:2180 N PARK AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2359
Mailing Address - Country:US
Mailing Address - Phone:407-629-6440
Mailing Address - Fax:
Practice Address - Street 1:2180 N PARK AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-629-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00506312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry