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1275531469

NPI Code Detail

MEDICARE: MS. PEDRO ANTONIO BLANDON M.D

MEDICARE: MS. PEDRO ANTONIO BLANDON M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L5254	TX
2	207RN0300X	Nephrology Physician	C1-0006902	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C1-0006902	OTHER	DE	DELAWARE LICENSE
2	L5254	OTHER	TX	TEXAS LICENSE
3	MD4244	OTHER	DE	CONTROLLED SUBSTANCE #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	M0145214	OTHER	TX	DPS (CONTROLLED SUBSTANCE

General Provider Information

NPI Number	:	1275531469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEDRO ANTONIO BLANDON M.D

Provider Business Mailing Address
First Line	:	PO BOX 9520
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79995-9520
Country	:	US
Telephone Number	:	915-760-5317
Fax Number	:	915-545-6634

Provider Business Practice Location Address
First Line	:	4801 ALBERTA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2707
Country	:	US
Telephone Number	:	915-545-6618
Fax Number	:	915-545-6634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/07/2023

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Directions to “ MS. PEDRO ANTONIO BLANDON M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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