Provider Demographics
NPI:1780633362
Name:DELRAY CARDIO-THORACIC SURGEONS, INC.
Entity Type:Organization
Organization Name:DELRAY CARDIO-THORACIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-499-2277
Mailing Address - Street 1:PO BOX 6746
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-6746
Mailing Address - Country:US
Mailing Address - Phone:561-499-2277
Mailing Address - Fax:561-499-0775
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-2277
Practice Address - Fax:561-499-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 12838208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0575Medicare PIN