Provider Demographics
NPI:1912099169
Name:BLANTON, JAMES RODNEY SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RODNEY
Last Name:BLANTON
Suffix:SR
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 1:63 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7835
Mailing Address - Country:US
Mailing Address - Phone:505-286-1086
Mailing Address - Fax:
Practice Address - Street 1:63 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7835
Practice Address - Country:US
Practice Address - Phone:505-286-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015190207Q00000X
NMMD2009-0099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine