Provider Demographics
NPI:1821203167
Name:BLANCO, GEORGE ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ERIC
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 1:601 7TH ST S STE 205
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4708
Mailing Address - Country:US
Mailing Address - Phone:727-893-6234
Mailing Address - Fax:727-553-7798
Practice Address - Street 1:601 7TH ST S STE 205
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4748
Practice Address - Country:US
Practice Address - Phone:727-893-6234
Practice Address - Fax:727-553-7798
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90494207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16156OtherBCBS
FL006491700Medicaid
FL16156OtherBCBS
FLAF450XMedicare PIN