Active NPI
William F Blank Jr.
- Dermatopathology (Pathology) Physician
- Chaffee, MO
National Provider Identifier
1740260652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology (Pathology) Physician
- License
- 34699
- Practice address
- 221 S Main
Chaffee, MO 63740 - Phone
- (573) 887-3632
- Fax
- (573) 887-3635
- NPI assigned
- Jan 18, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician | 207ZD0900X | 34699 | MO | Primary |
| Dermatopathology (Pathology) Physician | 207ZD0900X | IL |
Addresses
Primary practice location
221 S Main
Chaffee, MO 63740
Mailing address
221 S Main St
PO Box 216
Chaffee, MO 63740-1040
Phone (573) 887-3632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036081467 | IL | MD | Dermatopathology (Pathology) Physician |
| 34699 | MO | MD | Dermatopathology (Pathology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartland Laboratory Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Medical Laboratory
- Chaffee, MO
- NPI 1790976686
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740260652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 S MAIN ST",
"address_2": "PO BOX 216",
"city": "CHAFFEE",
"state": "MO",
"postal_code": "637401040",
"telephone_number": "573-887-3632",
"fax_number": "573-887-3635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 S MAIN",
"city": "CHAFFEE",
"state": "MO",
"postal_code": "63740",
"telephone_number": "573-887-3632",
"fax_number": "573-887-3635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "WILLIAM",
"middle_name": "F",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "MO",
"license": "34699",
"primary": true
},
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "IL",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chaffee, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.