=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487842506
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAYNE S BLOCKER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2007
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 N PARSONS AVE SUITE 101
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33510-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-681-9048
-----------------------------------------------------
Fax | 813-653-0088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 N PARSONS AVE SUITE 101
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33510-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-681-9048
-----------------------------------------------------
Fax | 813-653-0088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. WAYNE S BLOCKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-681-9048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME 26545
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------