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DEMETRI BLANAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
ROUTE 301 NORTH 21 B STREET, ZUNI, NM 87327-0467
(505) 782-7453
Mailing address
PO BOX 467, ZUNI, NM 87327-0467
(505) 782-7453

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
276545-1
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
96055049
NM
Enumeration date
06/20/2013
Last updated
03/23/2017
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