Individual
SHIRLEY BLANCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3950 S COUNTRY CLUB RD STE 130, TUCSON, AZ 85714-2099
(520) 874-4800
(520) 874-4801
Mailing address
3950 S COUNTRY CLUB RD STE 130, TUCSON, AZ 85714-2099
(520) 874-4800
(520) 874-4801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42772
AZ
207Q00000X
Family Medicine Physician
45683-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34469900
—
WI
Enumeration date
12/23/2005
Last updated
12/19/2012
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