Physician Compare National (NPI:1629139696)

HEALTHCARE PROVIDER: MARLON LEON BLANKS LICENSE CLINICAL SOC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629139696
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698948255
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160613000402
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLANKS
	Individual professional last name
Provider First Name	MARLON
	Individual professional first name
Provider Middle Name	LEON
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3651 LINDELL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	D325
	Group Practice or individual's line 2 address
City	LAS VEGAS
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	891031254
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2812224523
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y