Provider Demographics
NPI:1265538250
Name:BLANKENAU, ANDREW J (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:BLANKENAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOX HOLLOW RUN
Mailing Address - Street 2:
Mailing Address - City:SHADY SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5741
Mailing Address - Country:US
Mailing Address - Phone:940-726-6165
Mailing Address - Fax:
Practice Address - Street 1:4400 TEASLEY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-3403
Practice Address - Country:US
Practice Address - Phone:940-382-9898
Practice Address - Fax:940-383-3815
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83Y900OtherBCBS
TXJ3744OtherLICENSE
TX3250406OtherBLUELINK
TX75-2592653OtherTAX ID
TXBB3994452OtherDEA
TX83Y900OtherBCBS
TXJ3744OtherLICENSE