Provider Demographics
NPI:1215068556
Name:BLUNCK, REX ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ANDREW
Last Name:BLUNCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1932 S LAKEWOOD HLS
Mailing Address - Street 2:
Mailing Address - City:FRANCISCO
Mailing Address - State:IN
Mailing Address - Zip Code:47649-9045
Mailing Address - Country:US
Mailing Address - Phone:812-782-9292
Mailing Address - Fax:812-387-2045
Practice Address - Street 1:4000 TULIP TREE DR
Practice Address - Street 2:SS-I
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-2300
Practice Address - Country:US
Practice Address - Phone:812-387-2922
Practice Address - Fax:812-387-2045
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000288A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical