Healthcare Provider Details

I. General information

NPI: 1063594059
Provider Name (Legal Business Name): JOHN C BLANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 POSADA LN STE C
TEMPLETON CA
93465-4054
US

IV. Provider business mailing address

292 POSADA LN STE C
TEMPLETON CA
93465-4054
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-3133
  • Fax: 805-434-3850
Mailing address:
  • Phone: 805-434-3133
  • Fax: 805-434-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM1521
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC54710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: