Provider Demographics
NPI:1891787248
Name:BLANKENSHIP, LILIAN VILLEGAS (MD,)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:VILLEGAS
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HIGHLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1634
Mailing Address - Country:US
Mailing Address - Phone:254-690-4880
Mailing Address - Fax:254-690-6140
Practice Address - Street 1:3004 S W S YOUNG DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2023
Practice Address - Country:US
Practice Address - Phone:254-634-7337
Practice Address - Fax:254-634-2592
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000NT705Medicaid
B21309Medicare UPIN