Provider Demographics
NPI:1134147853
Name:BLANCHARD, LUCIUS (MD)
Entity type:Individual
Prefix:
First Name:LUCIUS
Middle Name:
Last Name:BLANCHARD
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 1:2285 CORPORATE CIR 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2100
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:4488 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5030
Practice Address - Country:US
Practice Address - Phone:702-436-1001
Practice Address - Fax:702-436-7999
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3617207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV070008523OtherRAILROAD MEDICARE
AZP00660180OtherMEDICARE RAILROAD AZ
ID11004210Medicare PIN
NV7WCCDP0Medicare PIN
PA126149YPTMedicare PIN
ID1100421Medicare PIN
AZP00660180OtherMEDICARE RAILROAD AZ
CABM742MMedicare PIN
CABM742UMedicare PIN
NV070008523OtherRAILROAD MEDICARE
CABM742NMedicare PIN
CABM742VMedicare PIN
CABM742ZMedicare PIN
CABM742OMedicare PIN
CABM742PMedicare PIN
CABM742QMedicare PIN
CABM742RMedicare PIN
NVCY038ZMedicare PIN
AZZ120557Medicare PIN
CABM742LMedicare PIN
CABM742YMedicare PIN
CABM742XMedicare PIN
CABM742SMedicare PIN
CABM742TMedicare PIN
CABM742WMedicare PIN
AZZ131412Medicare PIN
AZZ131536Medicare PIN