Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO 3186 | FL |
NPI | 1073584710 |
---|---|
Provider Name | Dr. Christopher John Blanco |
First Address | Medley, FL 33178-2510 |
Second Address | Miami, FL 33126-2072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 17/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204445857 | CIGNA (01) | TN |
2700492 | UNITED HEALTH CARE (01) | FL |
313984 | AVMED (01) | FL |
340554100 | (05) | FL |
65926 | BLUECROSS BLUE SHIELDS (01) | FL |
7060825 | AETNA (01) | FL |
V07243 | (02) | FL |