Healthcare Provider Details

I. General information

NPI: 1881783991
Provider Name (Legal Business Name): DONALD PATRICK BLEM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 NORTH OXFORD DR.
ENGLEWOOD FL
34223
US

IV. Provider business mailing address

80 NORTH OXFORD DR.
ENGLEWOOD FL
34223
US

V. Phone/Fax

Practice location:
  • Phone: 941-235-2710
  • Fax: 941-235-2712
Mailing address:
  • Phone: 941-235-2710
  • Fax: 941-235-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: