MEDICARE: DR. BLAINE RICHARD HERIC MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME73348	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01735276	OTHER	FL	RAILROAD MEDICARE PROVIDER NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1912971946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAINE RICHARD HERIC MD

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:	727-266-4943

Provider Business Practice Location Address
First Line	:	455 PINELLAS ST
Second Line	:	SUITE 320
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3369
Country	:	US
Telephone Number	:	727-446-2273
Fax Number	:	727-441-4966

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	12/05/2016

455 PINELLAS ST STE 330
CLEARWATER, FL
33756-3369

Practice Phone: 727-532-0002
Practice Fax:

455 PINELLAS ST , SUITE 320
CLEARWATER, FL
33756-3369