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Organization
WYNDAL K BLANKENSHIP MD PA
Active
Organization
WYNDAL K BLANKENSHIP MD PA
Active
Other names
WYNDAL K BLANKENSHIP MD
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE J ANDERSON (INS MANAGER)
(850) 678-6621
Entity
Organization
Contact information
Practice address
120 S JOHN SIMS PKWY, VALPARAISO, FL 32580-1212
(850) 678-6621
(850) 729-0331
Mailing address
120 S JOHN SIMS PKWY, VALPARAISO, FL 32580-1212
(850) 678-6621
(850) 729-0331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256934500
—
FL
01
—
46862
BC NUMBER
—
01
—
N1099
EDI SENDER NUMBER
FL
Enumeration date
08/23/2005
Last updated
12/08/2009
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