Individual
DR. E DAVID BLICKENSDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
353 FAIRMONT BLVD, RAPID CITY, SD 57701-7375
(605) 343-1333
(605) 343-6017
Mailing address
PO BOX 2760, RAPID CITY, SD 57709-2760
(605) 343-1333
(605) 343-6017
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
3704
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002907
WELLMARK NUMBER
SD
01
—
050025368
RAILROAD MEDICARE
SD
05
—
5707050
—
SD
Enumeration date
01/12/2006
Last updated
01/26/2017
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