Individual provider · NPI-1

Ernesto Antonio Blanco, MD

Internal Medicine · Farmington, NM

NPI number1235669649

StatusActive

Last updated in NPPESNov 14, 2024

Details

NPI: 1235669649
Entity type: Individual (NPI-1)
Name: Ernesto Antonio Blanco
Credential: MD
Sex: Male
Sole proprietor: Yes
Enumeration date: Jun 18, 2017
Certification date: Nov 14, 2024
Last updated: Nov 14, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	MD2020-0675	NM	Yes
390200000X	Student in an Organized Health Care Education/Training Program	–	–

Practice location

801 W Maple St
Farmington, NM 87401-5630

Phone 505-609-2258 · Fax 505-609-6074

Mailing address

Po Box 844088
Dallas, TX 75284-4088

Phone 505-609-2258 · Fax 505-609-2259

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