Individual
DR. BRYAN ANDREW BLANCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1631 ARLINGTON ST, ADA, OK 74820-2639
(580) 559-0001
(580) 559-0002
Mailing address
1631 ARLINGTON ST, ADA, OK 74820-2639
(580) 559-0001
(580) 559-0002
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
253
OK
213EP1101X
Primary Podiatric Medicine Podiatrist
253
OK
213ER0200X
Radiology Podiatrist
253
OK
213ES0000X
Sports Medicine Podiatrist
253
OK
213ES0103X
Foot & Ankle Surgery Podiatrist
253
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200119690A
—
OK
Enumeration date
03/14/2006
Last updated
02/22/2023
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