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NPI Code Detail

MEDICARE: DR. RAFAEL WILLIAM BLANCO M. D.

MEDICARE: DR. RAFAEL WILLIAM BLANCO M. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RX0202XMedical Oncology PhysicianME30523FL
2207RH0000XHematology (Internal Medicine) PhysicianME30523FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00679540OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
262236OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1164474615
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAFAEL WILLIAM BLANCO M. D.
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line : ATTN: CREDENTIAL DEPARTMENT
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 3402 W DR MARTIN LUTHER KING JR BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33607-6214
Country : US
Telephone Number : 813-875-3950
Fax Number : 813-876-0432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 03/24/2026

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