Provider Demographics
NPI:1235353269
Name:BLANCO, JAMES G (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:BLANCO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:6499 38TH AVENUE NORTH SUITE G1
Mailing Address - Street 2:PINELLAS CANCER CENTER
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1658
Mailing Address - Country:US
Mailing Address - Phone:727-381-3761
Mailing Address - Fax:727-347-9348
Practice Address - Street 1:6499 38TH AVENUE NORTH SUITE G1
Practice Address - Street 2:PINELLAS CANCER CENTER
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1658
Practice Address - Country:US
Practice Address - Phone:727-381-3761
Practice Address - Fax:727-347-9348
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA3195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine