Provider Demographics
NPI:1255335824
Name:GARY W. BLANCHARD, M.D., APMC
Entity type:Organization
Organization Name:GARY W. BLANCHARD, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MECHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-9977
Mailing Address - Street 1:1270 ATTAKAPAS DR
Mailing Address - Street 2:STE 502
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6530
Mailing Address - Country:US
Mailing Address - Phone:337-942-9977
Mailing Address - Fax:337-942-8006
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:STE 502
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6530
Practice Address - Country:US
Practice Address - Phone:337-942-9977
Practice Address - Fax:337-942-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09513R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429627Medicaid
LA1429627Medicaid