Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 45438 | TN |
N | 207V00000X | Obstetrician & Gynecologist | E-6247 | AR |
Y | 207V00000X | Obstetrician & Gynecologist | MD.204270 | LA |
NPI | 1003028762 |
---|---|
Provider Name | Dr. Eddye Blossom II |
First Address | Monroe, LA 71202-6400 |
Second Address | Monroe, LA 71202-6400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2138014 | (05) | LA |