Provider Demographics
NPI:1518791151
Name:JOHNNY BLANCHARD MD INC
Entity type:Organization
Organization Name:JOHNNY BLANCHARD MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-202-4613
Mailing Address - Street 1:4424 FULTON ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3863
Mailing Address - Country:US
Mailing Address - Phone:626-202-4613
Mailing Address - Fax:
Practice Address - Street 1:4424 FULTON ST APT 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3863
Practice Address - Country:US
Practice Address - Phone:626-202-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care