Individual
BLAINEY J. NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4847
(504) 837-8000
Mailing address
PO BOX 403, LABADIEVILLE, LA 70372-0403
(504) 376-3161
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
022044
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1974692
—
LA
Enumeration date
07/10/2006
Last updated
09/12/2014
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