Provider Demographics
NPI:1013994342
Name:BLANKENSHIP, JOHN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 LOWELL DR SE STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3755
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5954
Practice Address - Street 1:401 LOWELL DR SE STE 14
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3738
Practice Address - Country:US
Practice Address - Phone:256-534-7235
Practice Address - Fax:256-534-7268
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02709207Q00000X
ALDO630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64036296Medicaid
KYH15249Medicare UPIN
KY64036296Medicaid
KY0522605Medicare ID - Type Unspecified