Provider Demographics
NPI:1215285135
Name:BLANSON, ERIC R (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:R
Last Name:BLANSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:128 VISION PARK BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3017
Mailing Address - Country:US
Mailing Address - Phone:832-585-1620
Mailing Address - Fax:855-787-3211
Practice Address - Street 1:128 VISION PARK BLVD STE 135
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3017
Practice Address - Country:US
Practice Address - Phone:832-585-1620
Practice Address - Fax:855-787-3211
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT28-2012213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W887Medicare UPIN