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General NPI Number Information
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NPI Number | 1285961227
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Entity Type | Organization
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Legal Business Name | JACKY BLANK MD PA
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 20814 W DIXIE HWY
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City | AVENTURA
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State | FL
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Zip | 33180-1147
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Country | US
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Telephone | 305-933-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 20814 W DIXIE HWY
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City | AVENTURA
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State | FL
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Zip | 33180-1147
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Country | US
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Telephone | 305-933-8433
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JACKY BRUCE BLANK
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Credential | MD
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Telephone | 305-933-8433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME 101336
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License Number State | FL
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