Provider Demographics
NPI:1629386974
Name:MARTINEZ BLANCO, ELVIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELVIA
Middle Name:
Last Name:MARTINEZ BLANCO
Suffix:
Gender:F
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:12505 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8298
Practice Address - Country:US
Practice Address - Phone:972-963-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4197207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01498206OtherRAILROAD MEDICARE
TX349081502Medicaid
TX8FF420OtherBLUE CROSS BLUE SHIELD
P01498207OtherRAILROAD MEDICARE
TX8FG397OtherBLUE CROSS BLUE SHIELD
TX349081501Medicaid
P01498206OtherRAILROAD MEDICARE
P01498207OtherRAILROAD MEDICARE
TX349081501Medicaid