William F Blank Jr.
Individual provider Active NPI Dermatopathology (Pathology) Physician · Chaffee, MO
NPI 1740260652 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1740260652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatopathology (Pathology) Physician 207ZD0900X
- License
- 34699 (MO)
- Practice address
- 221 S Main
Chaffee, MO 63740 - Phone
- (573) 887-3632
- Fax
- (573) 887-3635
- NPI assigned
- Jan 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
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 |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatopathology (Pathology) Physician | 207ZD0900X | 34699 | MO | Yes |
| 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
Other providers in Chaffee, MO
- Nancy Blattel
- Carter P Fenton Sr Clinics Inc
- Chaffee Family Care LLC
- Chaffee Nursing, LLC
- Jason Crader
All providers in Chaffee, MO · Dermatopathology (Pathology) Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.