Individual
BERTHA J BLANCHARD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
105 ASBURY CIR, SUITE A, HATTIESBURG, MS 39402-1302
(601) 268-5222
(601) 296-3508
Mailing address
PO BOX 15548, HATTIESBURG, MS 39404-5548
(601) 268-5222
(601) 296-3508
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
11501
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111298
—
MS
Enumeration date
04/12/2006
Last updated
07/08/2007
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