Basic Information
| Provider Information | |||||||||
| NPI: | 1508150863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANCHARD | ||||||||
| FirstName: | TERIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623012834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172246423 | ||||||||
| FaxNumber: | 2172283251 | ||||||||
| Practice Location | |||||||||
| Address1: | 927 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623012719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172246423 | ||||||||
| FaxNumber: | 2172283251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2011 | ||||||||
| LastUpdateDate: | 10/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 74627 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036151162 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.