Provider Demographics
NPI:1962573055
Name:BLANCO, ALEX JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOSEPH
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10410 MEDICAL LOOP
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6612
Mailing Address - Country:US
Mailing Address - Phone:956-523-8900
Mailing Address - Fax:956-523-8903
Practice Address - Street 1:10410 MEDICAL LOOP
Practice Address - Street 2:UNIT 3B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6612
Practice Address - Country:US
Practice Address - Phone:956-523-8900
Practice Address - Fax:956-523-8903
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL1804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P9780OtherBLUE CROSS
TXL1804OtherLICENSE
TX148154106Medicaid
TXT0119526OtherDPS
TXT0119526OtherDPS
TXL1804OtherLICENSE
TX8P9780Medicare PIN