Provider Demographics
NPI:1912976481
Name:BLANCK, ZALMEN (MD)
Entity Type:Individual
Prefix:
First Name:ZALMEN
Middle Name:
Last Name:BLANCK
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 1:4411 MEDICAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3822
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:4411 MEDICAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3822
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-2413
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2251207RC0001X, 207RC0000X, 207RC0001X
WI27928-020207RC0000X
WI27928207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01447565OtherRR MEDICARE
TX392274YR99OtherMEDICARE
TX8EV934OtherBCBS
TX343671901Medicaid
TX8EV934OtherBCBS
TXP01447565OtherRR MEDICARE
001554475Medicare PIN
001546515Medicare PIN
TX343671901Medicaid
003404130Medicare PIN