Provider Demographics
NPI:1912021817
Name:BLANCO & CANTU FAMILY PRACTICE,P.A.
Entity Type:Organization
Organization Name:BLANCO & CANTU FAMILY PRACTICE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-523-8900
Mailing Address - Street 1:10410 MEDICAL LOOP UNIT 3B
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6376
Mailing Address - Country:US
Mailing Address - Phone:956-523-8900
Mailing Address - Fax:956-523-8903
Practice Address - Street 1:10410 MEDICAL LOOP UNIT 3B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6376
Practice Address - Country:US
Practice Address - Phone:956-523-8900
Practice Address - Fax:956-523-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8003OtherTX LIC
TXP00180482OtherMEDICARE RR
TX171139201Medicaid
TX8P9780OtherBLUE CROSS
TX8P9781OtherBLUE CROSS
TX171139202Medicaid
TXL1804OtherTC LIC
TXL1804OtherTC LIC
TXH42387Medicare UPIN
TX00878XMedicare ID - Type UnspecifiedMEDICARE GRP