=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780633362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELRAY CARDIO-THORACIC SURGEONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 05/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5130 LINTON BLVD SUITE B-5
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-6596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-499-2277
-----------------------------------------------------
Fax | 561-499-0775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6746
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33482-6746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-499-2277
-----------------------------------------------------
Fax | 561-499-0775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT E BLAIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-499-2277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | ME 12838
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------