Provider Demographics
NPI:1265553200
Name:BLANCHARD, ROGER JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JAMES
Last Name:BLANCHARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18838 HIGHWAY 3235
Mailing Address - Street 2:
Mailing Address - City:GALLIANO
Mailing Address - State:LA
Mailing Address - Zip Code:70354-4038
Mailing Address - Country:US
Mailing Address - Phone:985-475-5522
Mailing Address - Fax:985-475-4822
Practice Address - Street 1:18838 HIGHWAY 3235
Practice Address - Street 2:
Practice Address - City:GALLIANO
Practice Address - State:LA
Practice Address - Zip Code:70354-4038
Practice Address - Country:US
Practice Address - Phone:985-475-5522
Practice Address - Fax:985-475-4822
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10972R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA68058Medicaid
LA68058Medicaid