Individual
DEIDRA BLANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1839 QUIET CV, FAYETTEVILLE, NC 28304-3857
(910) 323-1463
(910) 323-1575
Mailing address
1839 QUIET CV, FAYETTEVILLE, NC 28304-3857
(910) 323-1463
(910) 323-1575
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
2006-00621
NC
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
2006-00621
NC
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
2011003947
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619170529
—
NC
Enumeration date
06/07/2007
Last updated
06/11/2021
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