MEDICARE: BENJAMIN J LINDBLOOM M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	ME132052	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	JA322Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XJZ3J	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1699065128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN J LINDBLOOM M.D.

Provider Business Mailing Address
First Line	:	21 HOSPITAL DR STE 110
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2453
Country	:	US
Telephone Number	:	386-586-1910
Fax Number	:	386-586-1912

Provider Business Practice Location Address
First Line	:	21 HOSPITAL DR STE 110
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2453
Country	:	US
Telephone Number	:	386-586-1910
Fax Number	:	386-586-1912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	02/09/2021

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