MEDICARE: R M BLATSTEIN DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P01563	FL

General Provider Information

NPI Number	:	1235134941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R M BLATSTEIN DPM PA

Provider Business Mailing Address
First Line	:	1635 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7229
Country	:	US
Telephone Number	:	772-225-3668
Fax Number	:	772-334-4115

Provider Business Practice Location Address
First Line	:	1635 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7229
Country	:	US
Telephone Number	:	772-225-3668
Fax Number	:	772-334-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/22/2010

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