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Pedro Antonio Blandon

Internal Medicine

Allopathic & Osteopathic Physicians

4801 Alberta Ave, El Paso, TX 79905-2707

PECOS Enrollment

This provider is enrolled in PECOS as PEDRO BLANDON.

Based on the most recent information from CMS, provider Pedro Antonio Blandon is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1275531469
Provider Type
Individual
Full Name
Blandon, Pedro Antonio
Title
Ms.
Credential
M.D

Gender
Male
Sole Proprietor
No
Enumeration Date
7/12/2005
Last Updated
3/7/2023

Contact Information

Practice Location

4801 Alberta Ave, El Paso, TX 79905-2707

(915) 545-6618

(915) 545-6634

Mailing Location

PO Box 9520, El Paso, TX 79995-9520

(915) 760-5317

(915) 545-6634

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License L5254 Texas
Code 207RN0300X	Description Internal Medicine Allopathic & Osteopathic Physicians	License C1-0006902 Delaware

Provider Identifiers

ID	Description	Issuer
ID C1-0006902	Description Other	Issuer DELAWARE LICENSE Delaware
ID L5254	Description Other	Issuer TEXAS LICENSE Texas
ID MD4244	Description Other	Issuer CONTROLLED SUBSTANCE # Delaware
ID 1000022966	Description Medicaid	Issuer Unlisted Delaware
ID M0145214	Description Other	Issuer DPS (CONTROLLED SUBSTANCE Texas

Pedro Antonio Blandon

PECOS Enrollment

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