Provider Demographics
NPI:1477366391
Name:BLANEKSPOOR, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:BLANEKSPOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DELAWARE AVE SW APT 4
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1700
Mailing Address - Country:US
Mailing Address - Phone:712-451-8971
Mailing Address - Fax:
Practice Address - Street 1:120 DELAWARE AVE SW APT 4
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1700
Practice Address - Country:US
Practice Address - Phone:712-451-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant