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General NPI Number Information
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NPI Number | 1871528562
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Entity Type | Organization
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Legal Business Name | EDGAR R BLECKER MD PA
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 229 SEBASTIAN BOULEVARD
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City | SEBASTIAN
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State | FL
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Zip | 32958
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Country | US
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Telephone | 772-581-0016
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Fax | 772-581-1198
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Provider Business Mailing Address
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Address Line | 229 SEBASTIAN BOULEVARD
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City | SEBASTIAN
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State | FL
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Zip | 32958
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Country | US
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Telephone | 772-581-0016
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Fax | 772-581-1198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDGAR RENE BLECKER
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Credential | MD
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Telephone | 772-581-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78368
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License Number State | FL
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