Individual
MR. DOUGLAS U. BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2985 CORTEZ AVE, IDAHO FALLS, ID 83404-7554
(208) 523-3373
(208) 523-8746
Mailing address
2985 CORTEZ AVE, IDAHO FALLS, ID 83404-2985
(208) 523-3373
(208) 523-8746
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M-7866
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
327497
BLUE SHIELD
—
05
—
805536100
—
ID
01
—
KOO J1338
BLUE CROSS
—
Enumeration date
06/17/2005
Last updated
08/23/2011
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