Individual
LARRY L BLANKENSHIP JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1210 MEDICAL ARTS BLVD STE 114, ANDERSON, IN 46011-3442
(765) 298-4545
(765) 298-4945
Mailing address
1210 MEDICAL ARTS BLVD STE 114, ANDERSON, IN 46011-3442
(765) 298-4545
(765) 298-4945
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01043570A
IN
2084N0600X
Clinical Neurophysiology Physician
01043570A
IN
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
01043570A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086592
ANTHEM BLUE CROSS & BLUE
IN
01
—
130012612
RAILROAD MEDICARE
—
05
—
200029250A
—
IN
Enumeration date
09/28/2006
Last updated
10/22/2019
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