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NPI Code Detail

MEDICARE: DR. FRED MASON BLOSSER DDS

MEDICARE: DR. FRED MASON BLOSSER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry11742TX

General Provider Information

NPI Number : 1467411884
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED MASON BLOSSER DDS
Provider Business Mailing Address
First Line : 3804 67TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-6009
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6104 AVENUE Q SOUTH DR
Second Line :
City : LUBBOCK
State : TX
Zip : 79412-3700
Country : US
Telephone Number : 806-472-3470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 07/08/2007

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Directions to “ DR. FRED MASON BLOSSER DDS” Practice Location

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