Healthcare Provider Details

I. General information

NPI: 1588077804
Provider Name (Legal Business Name): RENATO FILART BLANCO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4207
US

IV. Provider business mailing address

601 HAMILTON AVE RM B-158 ST. FRANCIS MEDICAL CENTER OFFICE OF GRADUATE MEDICAL E
TRENTON NJ
08629-1915
US

V. Phone/Fax

Practice location:
  • Phone: 904-702-6111
  • Fax:
Mailing address:
  • Phone: 609-599-5061
  • Fax: 609-599-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number133505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: