Provider Demographics
NPI:1104347053
Name:BLANKE, HARRY HERMAN III (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:HERMAN
Last Name:BLANKE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:807 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7271
Mailing Address - Country:US
Mailing Address - Phone:386-425-5554
Mailing Address - Fax:386-428-6291
Practice Address - Street 1:201 N CLYDE MORRIS BLVD, SUITE 200
Practice Address - Street 2:HALIFAX HEALTH FAMILY MEDICINE RESIDENCY PROGRAM
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-425-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN25062207Q00000X
FLME138930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine