Basic Information
| Provider Information | |||||||||
| NPI: | 1871528562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGAR R BLECKER MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 SEBASTIAN BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | SEBASTIAN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725810016 | ||||||||
| FaxNumber: | 7725811198 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 SEBASTIAN BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | SEBASTIAN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7725810016 | ||||||||
| FaxNumber: | 7725811198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | BLECKER | ||||||||
| AuthorizedOfficialFirstName: | EDGAR | ||||||||
| AuthorizedOfficialMiddleName: | RENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7725810016 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME78368 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0095910 | 01 | FL | WELLMED | OTHER | 35392 | 01 | FL | BLUE CROSS BLUE SHIELD OF FLORIDA | OTHER | DB1340 | 01 | FL | RAILROAD MEDICARE | OTHER |