Provider Demographics
NPI:1265410773
Name:BLANCARTE, GILBERT (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:BLANCARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:786 W PIONEER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8888
Practice Address - Country:US
Practice Address - Phone:702-345-5000
Practice Address - Fax:702-345-2000
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18312207R00000X
TXE6239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1265410773Medicaid
TX035898801Medicaid
NV18312OtherSTATE LICENSE