Individual
KEVIN P BLANCHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5680
(601) 268-5778
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5680
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
16509
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124393
—
MS
05
—
1035211
—
LA
01
—
640507572XJ
AMERICAN ADMIN GROUP
MS
Enumeration date
07/28/2006
Last updated
07/20/2020
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