Provider Demographics
NPI:1134152598
Name:DE BLOCK, JANETTE (MD)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:DE BLOCK
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 1:14506 W GRANITE VALLEY DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-6010
Mailing Address - Country:US
Mailing Address - Phone:623-214-1220
Mailing Address - Fax:623-516-9860
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:SUITE 117
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-214-1220
Practice Address - Fax:623-516-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16319207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ16319OtherMEDICAL LICENSE-AZ
AZMD16319Medicare PIN
C99342Medicare UPIN