Blank, Douglas U.

Blank, Douglas U. is an individual health care provider with primary practice located at 2985 Cortez Ave , Idaho Falls ID 83404-7554. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Blank, Douglas U. can be contacted via phone (208) 523-3373.

Contact Information

Primary practice address
2985 Cortez Ave Idaho Falls ID 83404-7554
Phone: (208) 523-3373
Fax: (208) 523-8746
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X M-7866 Idaho

Profile Details

NPI number 1871598631
LBN Legal business name Blank, Douglas U.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Aug 23rd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871598631 NPPES
Other 327497 BLUE SHIELD
MEDICAID 805536100 BLUE SHIELD
Other KOO J1338 BLUE SHIELD

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