Individual
ERNESTO ANTONIO BLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2258
(505) 609-6074
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2020-0675
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/18/2017
Last updated
11/14/2024
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