Individual
DERRICK BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
537 UNION AVE, GRANTS PASS, OR 97527-5543
(541) 507-2050
Mailing address
3987 N LIVINGSTON AVE, IDAHO FALLS, ID 83401-1482
(208) 346-3010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA204055
OR
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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