Provider Demographics
NPI:1275531469
Name:BLANDON, PEDRO ANTONIO (MD)
Entity Type:Individual
Prefix:MS
First Name:PEDRO
Middle Name:ANTONIO
Last Name:BLANDON
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:PO BOX 9520
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79995-9520
Mailing Address - Country:US
Mailing Address - Phone:915-760-5317
Mailing Address - Fax:915-545-6634
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-545-6618
Practice Address - Fax:915-545-6634
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5254207R00000X
DEC1-0006902207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0006902OtherDELAWARE LICENSE
TXL5254OtherTEXAS LICENSE
DEMD4244OtherCONTROLLED SUBSTANCE #
DE1000022966Medicaid
TXM0145214OtherDPS (CONTROLLED SUBSTANCE
TXM0145214OtherDPS (CONTROLLED SUBSTANCE
DE1000022966Medicaid
DEC1-0006902OtherDELAWARE LICENSE