Provider Demographics
NPI:1427101906
Name:BLANCHARD, LAWRENCE D (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:BLANCHARD
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 170129
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-0129
Mailing Address - Country:US
Mailing Address - Phone:713-816-9760
Mailing Address - Fax:
Practice Address - Street 1:7451 CHAPEL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7090
Practice Address - Country:US
Practice Address - Phone:817-294-7444
Practice Address - Fax:817-294-7172
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5458207L00000X
TN58320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116473306Medicaid
TXP00317178Medicare PIN
TXG85174Medicare UPIN
TX8731B9Medicare PIN
TX8G5614Medicare PIN
TXDE7892Medicare PIN