Provider Demographics
NPI:1851300446
Name:BLANKENSHIP, HOWARD KIRBY (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:KIRBY
Last Name:BLANKENSHIP
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 1:1009 SHIPWATCH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5736
Mailing Address - Country:US
Mailing Address - Phone:855-834-6911
Mailing Address - Fax:813-354-2714
Practice Address - Street 1:3380 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1539
Practice Address - Country:US
Practice Address - Phone:855-834-6911
Practice Address - Fax:813-354-2714
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122202085N0904X, 2085R0202X
FLME00122202085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71373SOtherORIGINAL MEDICARE PTAN
FL0463130000Medicaid
FL71393OtherBLUE CROSS
FL0463130000Medicaid
D58052Medicare UPIN