MEDICARE: SHIRLEY BLANCAS 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
1	207Q00000X	Family Medicine Physician	45683-020	WI
2	207Q00000X	Family Medicine Physician	42772	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1942287628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY BLANCAS M.D.

Provider Business Mailing Address
First Line	:	3950 S COUNTRY CLUB RD STE 130
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-2099
Country	:	US
Telephone Number	:	520-874-4800
Fax Number	:	520-874-4801

Provider Business Practice Location Address
First Line	:	3950 S COUNTRY CLUB RD STE 130
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-2099
Country	:	US
Telephone Number	:	520-874-4800
Fax Number	:	520-874-4801

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	12/19/2012

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Directions to “ SHIRLEY BLANCAS M.D.” Practice Location

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