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General NPI Number Information
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NPI Number | 1851525406
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Entity Type | Individual
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Provider Name | BLESSY MATHEW JACOB M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 714 DOCTORS DR
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City | ENGLEWOOD
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State | FL
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Zip | 34223
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Country | US
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Telephone | 941-460-1300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102222
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City | ATLANTA
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State | GA
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Zip | 30368-2222
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Country | US
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Telephone | 239-432-8500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | ME113758
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | ME113758
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License Number State | FL
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