Provider Demographics
NPI:1225385891
Name:BLANCO, FELIX CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:CRISTOBAL
Last Name:BLANCO
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 1:10 4TH SEAVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334
Mailing Address - Country:US
Mailing Address - Phone:320-634-2276
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:10 FOURTH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-2276
Practice Address - Fax:320-634-2244
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55562208D00000X
DCMD038224282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital