MEDICARE: DR. ALAN MORTON BLANK MD

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
1	207VG0400X	Gynecology Physician	GFE13346	CA

General Provider Information

NPI Number	:	1306051511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN MORTON BLANK MD

Provider Business Mailing Address
First Line	:	PO BOX 2434
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-2434
Country	:	US
Telephone Number	:	858-756-2917
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 EL SICAMORO
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-2434
Country	:	US
Telephone Number	:	858-756-2917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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