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General NPI Number Information
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NPI Number | 1104666197
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Entity Type | Organization
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Legal Business Name | BLUE MEDICAL INC
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 4651 GREEN PALM LN
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City | KISSIMMEE
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State | FL
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Zip | 34746-5991
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Country | US
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Telephone | 201-993-1475
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Fax |
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Provider Business Mailing Address
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Address Line | 4651 GREEN PALM LN
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City | KISSIMMEE
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State | FL
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Zip | 34746-5991
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Country | US
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Telephone | 201-993-1475
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Fax |
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Authorized Official
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Title or Position | PRIMARY CARE PHYSICIAN
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Name | DR. ERICKSON ANGEN BALDERA GARCES
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Credential | MD
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Telephone | 201-993-1475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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