Individual
HOLLY AKIN BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8288 S BROADWAY AVE, TYLER, TX 75703-5262
(903) 606-7060
(903) 606-7025
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
P2830
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3030478801
—
TX
01
—
752616977028
TRICARE
TX
01
—
752616977118
TRICARE
TX
01
—
8DG294
BCBS
TX
Enumeration date
06/23/2009
Last updated
08/12/2016
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