Individual
DR. TRAVIS J BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6300 MAIN ST, ZACHARY, LA 70791-4037
(225) 658-4000
(225) 763-9997
Mailing address
8230 SUMMA AVE STE C, BATON ROUGE, LA 70809-3465
(225) 757-0552
(817) 332-7349
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
N6818
TX
390200000X
Student in an Organized Health Care Education/Training Program
200926
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1090646
—
LA
Enumeration date
07/25/2007
Last updated
05/17/2021
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