Provider Demographics
NPI:1134158066
Name:BLANCO, GLORIA BRIONES (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:BRIONES
Last Name:BLANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:BLANCO
Other - Last Name:MCMULLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-0799
Mailing Address - Country:US
Mailing Address - Phone:563-864-7221
Mailing Address - Fax:563-864-7224
Practice Address - Street 1:124 WEST GREENE STREET
Practice Address - Street 2:
Practice Address - City:POSTVILLE
Practice Address - State:IA
Practice Address - Zip Code:52162
Practice Address - Country:US
Practice Address - Phone:563-864-7221
Practice Address - Fax:563-864-7224
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28577OtherBLUE CROSS/BLUE SHIELD IA
IA28577Medicare ID - Type Unspecified
IA28577OtherBLUE CROSS/BLUE SHIELD IA