Individual
DR. JACKY BRUCE BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6200 SW 73 STREET, MIAMI, FL 33143-7679
(786) 662-8400
(786) 662-5314
Mailing address
6200 SW 73 STREET, MIAMI, FL 33143-7679
(786) 662-8400
(786) 662-5314
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
MD 030949 E
PA
207RP1001X
Pulmonary Disease Physician
ME 101336
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME101336
FL
Other
Enumeration date
04/14/2010
Last updated
01/28/2011
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