Provider Demographics
NPI:1841464625
Name:BLANNER, CHRIS FEIGHTNER (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:FEIGHTNER
Last Name:BLANNER
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 1:300 WINDING WOODS DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4771
Mailing Address - Country:US
Mailing Address - Phone:636-978-8600
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR
Practice Address - Street 2:SUITE 222
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4771
Practice Address - Country:US
Practice Address - Phone:636-978-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007279207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1841464625Medicaid
MOP01357810OtherRAILROAD MEDICARE
MOP01357810OtherRAILROAD MEDICARE