Provider Demographics
NPI:1508843392
Name:BLANCO, ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
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 1:8401 DATAPOINT, SUITE 600
Mailing Address - Street 2:P. O. BOX 29441
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0441
Mailing Address - Country:US
Mailing Address - Phone:210-616-7796
Mailing Address - Fax:210-616-7799
Practice Address - Street 1:8401 DATAPOINT DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5907
Practice Address - Country:US
Practice Address - Phone:210-616-7700
Practice Address - Fax:210-616-7709
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE42102085B0100X, 2085N0700X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1345209-08Medicaid
TX8L26749OtherMEDICARE - STRIC
E03324Medicare UPIN
TX1345209-08Medicaid