Individual
MICHAEL SCOTT BLANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3350 EXECUTIVE DR, SUITE 100, SAN ANGELO, TX 76904-6878
(325) 245-4501
(325) 245-4008
Mailing address
125 S PARK DR, STE H, BROWNWOOD, TX 76801-5952
(325) 641-8648
(325) 643-2227
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
L3583
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151420001
—
TX
05
—
151420002
—
TX
05
—
151420003
—
TX
01
—
8U8633
BLUE CROSS
TX
Enumeration date
07/04/2006
Last updated
03/02/2021
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