Provider Demographics
NPI:1427090562
Name:BLANKENSHIP, BRAD E (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:E
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330699
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-0699
Mailing Address - Country:US
Mailing Address - Phone:931-507-4500
Mailing Address - Fax:931-507-4502
Practice Address - Street 1:306 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2048
Practice Address - Country:US
Practice Address - Phone:931-507-4500
Practice Address - Fax:931-507-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17499207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735031Medicaid
TNMD17499OtherMEDICAL LICENSE
TN3735031Medicaid
TN3735031Medicare PIN