Provider Demographics
NPI:1730168683
Name:BLANTON, GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BLANTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 GENOVA WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5227
Mailing Address - Country:US
Mailing Address - Phone:561-386-1959
Mailing Address - Fax:954-418-1698
Practice Address - Street 1:4855 W HILLSBORO BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4356
Practice Address - Country:US
Practice Address - Phone:954-418-1683
Practice Address - Fax:954-418-1698
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82816OtherBCBS
FLP00150300OtherRRMCR
FL046510101Medicaid
FL82816OtherBCBS
FL046510101Medicaid